RV HOMOEO

*Name
Email
*Tele
*Cell
*Fax
*Full Address		Residence / Office
OP No.(Old case)
*CHIEF COMPLAINT		Duration, History of chief complaints. (viz. How the complaint had started? How it developed? What are the events during the course? and any other relevant data)
*Sex	Male Female
*Marital Status
*Date of Birth
*Place of Birth
Religion
*Age
*Height
*Weight
	GENERAL
	Smoke Drink
Nutritional status
Appearance
Hair
Skin
Nails
Appetite
Thirst
Sleep
Dreams
Cravings
Aversions
Bowels
Urine
Sweat
Sexual function
PAST HISTORY		Any illness or similar ailment in the past, Treatment history What all treatments taken for this ailment or any other ailment? And add a list of medicines taking and for what ailment?
Other Symptoms
General Examination
Mile stones of developments
SYSTEMIC EXAMINATION		Add any symptom from Head to foot or any examination findings. Head, Scalp, Eye, Ear, Nose, Mouth, Teeth, Face, Tongue, Respiratory, Cardiovascular, Genitourinary, Gastro intestinal tract (from mouth to rectum and anus)
	REACTION TO HEAT AND COLD Any aggravation or amoeliration to heat or cold
Hot weather	Like Hate Just OK
Cold weather	Like Hate Just OK
Warm food	Like Hate Just OK
Cold food	Like Hate Just OK
Warm water	Like Hate Just OK
Female complaints		Before, During and After Menses
MIND		Add a detailed summary of all the emotional mental intellectual subconscious sensations and functions felt by you
Detailed list of Investigation reports
Any other relevant information
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