*Name
Email
*Tele
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
*Enter the code
 


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