ADULT HEALTH HISTORY
1. Identifying data
Name
Age
Gender
Date of Birth
Marital status
Occupation
2. Reliability
3. Chief Complaint/s (State it as is sa pag say sa patient “…”)
4. Present Illness
Onset
Location
Duration
Character (Quality, Quantity)
Aggravating Factors
Radiation
Timing
5. Past History
Childhood Illnesses
–
–
–
–
Vaccinations
Accidents/Trauma
Medications
Illnesses
Adult Illnesses
–
Medical
- Hospitalizations
- Illnesses
–
Surgical
- Dates (Procedures done)
- Types of Operations
–
OBGYNE
- Obstetric History
- Pregnancies
- Living/Dead Offsprings
- Normal/CS delivery
- Menstrual History
- Menarche
- Menopause
- Contraception
- Sexual Function
Health Maintenance
- Immunizations
- Screening Tests
- Laboratory Tests
- Ancillary procedures
6. Family History
Immediate Family Data
- Parents and Siblings
- Living/Deceased
- Cause of Death
- Age
- Health History
7. Personal and Social History
Spouse/Partner
- Living/Deceased
- Cause of Death
- Age
- Occupation
- Health History
Offspring/s
- Living/Deceased
- Cause of Death
- Age
- Occupation
- Health History
Work
Educational Attainment
Hobbies
Hobbies
Lifestyle
Stressors-Destressors
Sexual Orientation
Sexual Practices
8. Review of Systems
General
Skin
Head, Eyes, Ears, Nose, Throat
Neck
Breasts
Respiratory
Cardiovascular
Gastrointestinal
Peripheral vascular
Urinary
Genital
Musculoskeletal
Psychiatric
Neurologic
Hematologic
Endocrine