REVIEW OF SYSTEMS Pain? General Weight Loss? (confirm with objective measurement and Sores or non-healing ulcers in/around mouth? other indicators: e.g. pants and other clothes no longer fit) Masses or growths? Weight gain? Change in hearing acuity? Fatigue? Ear pain or discharge? Difficulty sleeping? Nasal discharge, post nasal drip? Feeling well (or poorly) in general? Change in voice/hoarseness? Recent medical evaluations or treatments? Tooth pain or problems? Chronic pain? Sense of lump/mass (globus) in throat w/ Fevers, chills, sweats, weight loss? swallowing? Others? Others? Vision Pulmonary Chronic or past eye disorders? Chronic or past pulmonary disorders? • glaucoma, macular degeneration, DM retinal • COPD, asthma, other disease, other Shortness of breath - @ rest or w/exertion? Decrease/change in vision or blurriness? With or without pain? Chest pain? Double vision? Cough? Eye discharge (D/C)? Hemoptysis (coughing up blood)? Red Eye? Wheezing? Others? Snoring or stop breathing? Head and Neck (H&N) Others? Chronic or past head and neck disorders? Cardiovascular (C/V) Chronic cardiovascular disorders? • Nausea or Vomiting? Hypertenion, hyperlipidemia, congestive heart failure, valvular heart disease, coronary artery Abdominal swelling or distention? disease, peripheral vascular disease, stroke, etc Jaundice (yellowish coloration of skin)? Chest pain (CP) or pressure? Vomiting blood (hematemasis)? Shortness of breath - @ rest or w/exertion? Black/tarry stools? Orthopnea (short of breath lying down)? Bloody stools? Paroxysmal Nocturnal Dyspnea (PND)? - sudden Constipation? shortness of breath that awakens pt from sleep Diarrhea or other change in bowel habits? Lower extremity edema? Others? Sudden loss of consciousness (syncope)? Genito-Urinary Sense of rapid or irregular heartbeat, palpitations? Chronic or past GU disorders? • Calf/leg pain/cramps w/ambulation? BPH, cancer, stones, intrinsic renal disease, etc Wounds/ulcers in feet? Difficult/slow to heal? Blood in urine? Others? Burning with urination? Gastrointestinal Urination at night? Chronic or past GI disorders? • ulcers, hepatitis, inflammatory bowel disease, Incontinence (unintentional loss of urine)? cancer, irritable bowel syndrome, etc Urgency? Heart burn/sub-sternal burning? Frequency? Abdominal pain? Incomplete emptying? Hesitancy? Decreased Difficulty swallowing? force of stream? Need to void soon after urinating? Pain upon swallowing? Others? Hematology/Oncology • Chronic or past Heme/Onc disease? • Stroke, seizure, neurodegenerative - Multiple sclerosis, ALS, etc solid or liquid malignancies; benign hematological diseases, etc Sudden loss of neurological function? Fevers, chills, sweats, weight loss? Abrupt loss/change in level of consciousness? Abnormal bleeding/brusing? Witnessed seizure activity? New/growing lumps or bumps? Numbness? Hypercoaguability? Weakness? Others? Dizziness? Ob/Gyn/Breast Balance problems? Chronic or past disease? • Infertility, endometriosis, infection, cancer, etc Headache Menstrual Hx? Others? Sweats? Endocrine Known Endocrine disorder? Past pregnancies? • Diabetes, hypo/hyperthyroidism, etc Vaginal Discharge? Polyuria, polydypsia, polyphagia? # Sexual partners & type of sexual activity? Fatigue? Breast mass, pain or discharge? Weight loss? Therapeutic or spontaneous abortions? Weight gain? Hx STIs? Infectious Diseases Known disease? Others? • TB, HIV, endocarditis, chronic hepatitis B or C, immune compromised state, other Neurological Known disease? o acute or chronic infections, etc Fevers, Chills, Sweats? Confusion? Others? Others? Musculoskeletal Skin and Hair More Info About Musculoskeletal Disorders: Hair Loss Known disease? • Degenerative joint disease/Osteoarthritis, Known disease? Rheumatoid Arthritis, Lupus, gout, etc. • cancer, psoriasis, alopecia, etc Joint pain and/or Swelling (general comments) Skin eruptions/rashes? Muscle ache? Growths? Low back pain? Sores that grow and/or don't heal? Knee pain/swelling? Lesions changing in size, shape, or color? Hand Symptoms? Itching? Elbow symptoms? Others? Hip area symptoms? Shoulder pain or symptoms? Others? Mental Health Known mental health disorder? • depression, anxiety, schizophrenia, etc Do you feel sad or depressed much of the time? Alcohol, other substance abuse? Anxious much of the time? Memory problems?
