a guide in a form of outlines for history taking from pediatric patients. it is written in a way that eases the process of information collecting from patinets as its organized and easily filled out.
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Â
History Taking - 40 Character Title
1. History Taking
i. Biographical data
Name: _________ Medical diagnosis: _________
Age: _________ Occupation: _________
Gender: _________ Admission date: _________
Via: __________
Address:_________ Race: _________
Religion: _________ Birth date/ place: _________
Blood type:_________ Sourceof data: _________
Parent's education: Mother_______ /Father________
Date of interview: ___________
2. ii. Chief complaint/ Reason for seeking care (cc)
(One or two major symptom + their last occurrence before admission)
______________________________________________
______________________________________________
iii. Present illness (PI)
asbbreviatedA.obtain all details related to the chief complaintTo(
)P.Q.R.S.T.U.A
P
Palliative/what can decrease the symptom: ________________________
Provocative/ what can increase the symptom: _____________________
___________________________________________________________
3. Q
Quality/ how can you describe the symptom: ______________________
R
Region/ where has the symptom occurred on your body:______________
Radiation/ does it radiate to other parts of the body. If yes, where: _____
S
Severity/ on a pain scale of 1-10, how much is your pain: _____________
T
Timing
Onset/ when & how did the pain or symptom start: _________________
__________________________________________________________
Duration/ for how long does it last: ________________________ ______
4. Frequency/ how many times a day does it happen: __________________
U
(Quoted statement from the patient or parents)
Understanding/ what did you thought the symptom is indicating for:
"____________________________________________________
_____________________________________________________"
A
Associated factors/was the symptom associated with other symptoms:
___________________________________________________________
Write present illness as a paragraph
6. iv. Past illness (ph)
A- Birth history
If patient is under 2 years, collect it:
/ mother health during pregnancy, any illness (HTN, DM,Pregnancy-
hemorrhage), or any infections: _________________________________
X-ray: ______________ nutrition: _____________
Gestation time : _________months
Were problems faced during past pregnancy, yes/no. What were
They? ________________________________________________
______________________________________________________
/ when did your contractions first start: ________________Labor
How often were your contractions coming: _________________
Were they getting stronger_________werethey regular________
.vaginal or cesarean: Was itDelivery
:Child condition at birth
Crying: yes/ no
Basic problems ( with respiration..ect):______________________
7. Birth injury: Yes/no. What was it ________________
Birth weight: __________kg
Skin color: cyanosis ( ) jaundice ( ) fever ( ) rash ( )
B- Previous illnesses, injuries, or operations
Previous illnesses: _____________________________________
Injuries: __________________________when________________
Surgical operations/ pervious hospitalization:
Cause_________________________________________________
Date__________________________________________________
Treatment_____________________________________________
C- Allergies
Does the patient have allergies from food, medication, any other
agents like pets, or house hold products, what is the reaction?
_____________________________________________________
________________________________________________
D- Current medications
___________________________________________________________
8. ___________________________________________________________
ImmunizationsE-
The name of the disease/vaccination: ___________________________
The number of injections: ______________________________________
___________________________________________________________
The ages when administered: ___________________________________
The dosage(was the dosageof the vaccinations lessened or did they give
it to the patient fully):_________________________________________
__________________________________________________________
Vaccination not given_____________cause_______________
HabitsF-
Hours of sleep and arising:___________________________________
9. Regularity of stools and urination/ how many times a day:
___________________________________________________________
G- Growth and development
Growth
•Approximate/current weight at 6 months, 1 year, 2 years, and 5 years of
age:
________________________________________________________
•Approximate/current length at ages 1 and 4 years:
_________________________________________________________
ď‚· Head/chest circumference:
_______________________________________________________
•Dentition, including age of onset, number of teeth, and symptoms
during teething:
___________________________________________________________
Developmental milestones include:
Gross motor:
• Age of holding up head steadily: _______________________________
ď‚· Can patient sit/ walk:______________________________________
Age of sitting alone_____________________walking____________
Fine motor:
10. ď‚· Can patient Hold a spoon/draw/pickup something:_______________
Smiling: ________
Language:
• Age of saying first words with meaning: _________________________
ď‚· Can patient talk/understand what others say:_____________________
Sociality:
• Interactions with other children, peers, and adults:__________________
Other questions:
• Present grade in school: ______________________________________
• Scholastic performance:______________________________________
• If the child has a best friend:__________________________________
H- Family medical history (used primarily to discover any hereditary
or familial diseases inthe parents and child.)
chronic illnesses in the tree family of patient parents, their immediate aunts and
uncles, and their grandparents ( heart problems, hypertension, cancer, obesity,
cancer, DM…etc)
Age of mother______ Father ________
Illness (HTN, DM..etc): mother_________ ____father_______________
Siblings: How many_______ age of each______________________
_________________________________illness__________________
Grandparents: Age of grandmother _______grandfather_______
If anyone deceased name cause/ date:
___________________________________________________________
___________________________________________________________
11. I- Family structure:
• Family composition: _____________________________________
• Home and Community Environment: _______________________
• Monthly income: _______________________________
• Occupation and Education of Family Members:________________
______________________________________________________
______________________________________________________
G- Feeding history/ diet/ nutrition assessment(significant in
child less than 2 years):
• Type of feeding: breast fed Yes/No. If yes,
duration_____________
Bottle fed Yes/No. if yes, at which age_______,
composition of formula______________________,
amount_____________ml, frequency/day____________
• Supplements (iron, vitamins..etc): ___________________
________________________________________________
• Current diet:______________________________________
K- PsychosocialHistory:
Fears: adaption/regression: