The following is an example of an excellent HPI- thorough and concise. Does nice job of
highlighting PERTINENT details in addition to OPPQRST!
HPI: Yesterday NR woke up with pain on the ball of her left foot which she describes as
feeling like a bruise. Soon after, she noticed a rash on the ball of her left foot which
began to rapidly spread from the foot to the toes and then up her leg. Shortly after, the
rash presented on the right leg. As the rash spread, NR felt that she could not wait until
morning to seek care from her primary care physician so she presented to the hospital at
10:30 pm. By the time she was in her hospital gown the rash had spread up both of her
legs to the inner thighs and appeared on her right arm. She is not aware of anything that
makes the rash or the joint pain worse. She attempted to treat herself with naproxen and
hydrocortisone but neither was effective. Upon presentation, NR describes her rash as a
stinging pain which was a 6/10 on the pain scale. Since being admitted and treated with
Norco the rash does not sting anymore and she rates it at a 4/10, but says she only
experiences pain when she moves. The rash radiated as previously described but
currently is isolated to the feet and ankles with a small segment on the right inner thigh
and a small segment on the right inner arm. The pain presented with edema in the feet
which was alleviated by elevating the legs. She is also experiencing a foul smelling, dark
vaginal discharge which began 2 days ago. NR is currently finalizing a divorce and has
begun a new sexual relationship with another man as of 2 months ago.The patient
believes that her current symptoms are either caused by an STI, either gonorrhea or
Chlamydia, or from an exposure she had working as a nurse.
Below is an excellent and thorough example of ROS:
Review of Systems:
General: reports +fatigue, +weight loss; denies fever, chills, weakness, or trouble sleeping.
Skin: +lumps, denies rashes, itching, dryness, or color changes
Head: denies headache or head injuries
Ears: reports decreased hearing in right ear and earache, denies tinnitus
Eyes: denies blurry or double vision, pain, discharge or redness
Nose: denies stuffiness, discharge, nosebleeds or sinus pain
Throat: denies sore throat, dry mouth, hoarseness, or bleeding.
Neck: denies swollen glands, pain or stiffness
Respiratory: denies cough, hemoptysis, shortness of breath, or wheezing
Cardiovascular: denies chest pain, tightness, palpitations, orthopnea, paroxysmal nocturnal
dyspnea and edema
Gastrointestinal: complains of constipation, positive for nausea, vomiting, melena, denies
diarrhea or hematochezia, denies hematemesis.
Urinary: denies frequency urgency, burning, hematuria or incontinence
Musculoskeletal: +back pain, +joint pain, denies swelling, stiffness
Neurologic: +numbness, +tingling on fingers and toes, denies dizziness, fainting, seizures
Endocrine: denies polyuria, polydypsia, sweating, or heat or cold intolerance
M2 Physicianship
Applied Physical Diagnosis
Excellent examples of H&Ps part 1