REVIEW OF SYSTEMS CONSTITUTIONAL: fever, chills, weight loss or gain, weakness EYES: vision loss, vision change, pain, double vision, redness, glasses or contacts, glaucoma, cataracts, last eye doctor appointment ENT EARS: hearing changes, ringing in ears, dizziness, discharge, pain NOSE: congestion, runny nose, sinus pain, allergies THROAT: sore throat, hoarseness, voice changes, mouth sores, dentures, last dental visit CARDIOVASCULAR: chest pain or discomfort, tightness, palpitations, racing heart, short of breath with activity, difficulty breathing lying down, swelling, sudden awakening from sleep short of breath, high blood pressure, high cholesterol, heart attack, leg cramping RESPIRATORY: cough, sputum, coughing up blood, wheezing, short of breath, painful breathing GASTROINTESTINAL: problems swallowing, heartburn, indigestion, change in appetite, nausea, vomiting, diarrhea, constipation, change in bowel habits, blood in stool, last colonoscopy FEMALE GENITOURINARY: urinary frequency, urgency, incontinence, burning or pain, blood in urine. Vaginal discharge, pain with intercourse, date of last menstrual cycle, sexual practices, OB history @ GTPAL= gestation, term, preterm, abortion, living MALE GENITOURINARY: decreased force of urine stream, hesitance, frequency, urinating at night, penile discharge, erectile dysfunction, change in libido, sexual practices MUSCULOSKELETAL: muscle or joint pain, stiffness, back pain, redness or swelling of joints, injuries, any joint replacement surgeries INTEGUMENTARY: (breast/skin) rashes, lumps, itching, hair or nail changes, changing or new moles, breast pain, breast lumps, breast changes NEUROLOGICAL: headache, head injury, dizziness, fainting, seizures, tremor, tingling, numbness, memory loss, balance problems, falls PSYCHIATRIC: depression, anxiety, stress, nervousness, excessive worry, decreased need for sleep, diminished interest in activities, feelings of hopelessness, suicidal or homicidal thoughts ENDOCRINE: heat or cold intolerance, sweating, frequent urination, unexplained weight loss, excessive hunger or thirst HEMATOLOGIC/LYMPHATIC: easy bruising, excessive bruising, easy bleeding, anemia, blood disease, cancer, enlarged glands or lymph nodes, blood transfusions ALLERGIC/IMMUNOLOGIC: eczema, medication or environmental allergies, hives, hay fever, rheumatoid arthritis, lupus, psoriasis
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R"E"V"I"E"W"""""O"F""""S"Y"S"T"E"M"S"
CONSTITUTIONAL:"fever,&chills,&weight&loss&or&gain,&weakness&EYES:"vision&loss,&vision&change,&pain,&double&vision,&redness,&glasses&or&contacts,&glaucoma,&cataracts,&last&
eye&doctor&appointment&
ENT!EARS:!hearing&changes,&ringing&in&ears,&dizziness,&discharge,&pain!NOSE:!congestion,&runny&nose,&sinus&pain,&allergies&
THROAT:"sore&throat,&hoarseness,&voice&changes,&mouth&sores,&dentures,&last&dental&visit&CARDIOVASCULAR:!chest&pain&or&discomfort,&tightness,&palpitations,&racing&heart,&short&of&breath&with&
activity,&difficulty&breathing&lying&down,&swelling,&sudden&awakening&from&sleep&short&of&breath,&high&blood&pressure,&high&cholesterol,&heart&attack,&leg&cramping&&
RESPIRATORY:!cough,&sputum,&coughing&up&blood,&wheezing,&short&of&breath,&painful&breathing&
GASTROINTESTINAL:"problems&swallowing,&heartburn,&indigestion,&change&in&appetite,&nausea,&vomiting,&diarrhea,&constipation,&change&in&bowel&habits,&blood&in&stool,&last&colonoscopy!
FEMALE!GENITOURINARY:!urinary&frequency,&urgency,&incontinence,&burning&or&pain,&blood&in&urine.&Vaginal&discharge,&pain&with&intercourse,&date&of&last&menstrual&cycle,&sexual&practices,&OB&history&@GTPAL=&gestation,&term,&preterm,&abortion,&living&
MALE!GENITOURINARY:&decreased&force&of&urine&stream,&hesitance,&frequency,&urinating&at&night,&penile&discharge,&erectile&dysfunction,&change&in&libido,&sexual&practices&
MUSCULOSKELETAL:!muscle&or&joint&pain,&stiffness,&back&pain,&redness&or&swelling&of&joints,&injuries,&any&joint&replacement&surgeries&
INTEGUMENTARY:"(breast/skin)"rashes,&lumps,&itching,&hair&or&nail&changes,&changing&or&new&moles,&breast&pain,&breast&lumps,&breast&changes"
NEUROLOGICAL:"headache,&head&injury,&dizziness,&fainting,&seizures,&tremor,&tingling,&numbness,&memory&loss,&balance&problems,&falls&
PSYCHIATRIC:&depression,&anxiety,&stress,&nervousness,&excessive&worry,&decreased&need&for&sleep,&diminished&interest&in&activities,&feelings&of&hopelessness,&suicidal&or&homicidal&thoughts&
ENDOCRINE:!heat&or&cold&intolerance,&sweating,&frequent&urination,&unexplained&weight&loss,&excessive&hunger&or&thirst&
HEMATOLOGIC/LYMPHATIC:!easy&bruising,&excessive&bruising,&easy&bleeding,&anemia,&blood&disease,&&&cancer,&enlarged&glands&or&lymph&nodes,&blood&transfusions&
ALLERGIC/IMMUNOLOGIC:!eczema,&medication&or&environmental&allergies,&hives,&hay&fever,&rheumatoid&arthritis,&lupus,&psoriasis&
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