1.

Introduce yourself to patient

2. Ask How can I help you?
3. Ask about the reason for the visit (Chief Complaint): Pallor and easy
fatigability over the past one month

4.
5.
6.
7.
8.

Time of onset, frequency, duration

Character/quality of chief complaint
Exacerbating Factors
Relieving factors
Associated symptoms:

Shortness of breath/ dyspnea on exertion

Pallor/ jaundice
Urine discoloration
Change in stool color (any blood per rectum or tarry stools)
Heavy menses (in female patient)
Nonspecific complaints, such as headache, irritability, malaise
Weight loss
Fever
Easy bruisability
Loss of proprioception
Burning sensation in the tongue
Paresthesias and unusual sensations

9. Dietary history: intake of red meat; green leaves; cereals and legumes
10. Past medical/surgical history:

Recent viral illness

Recurrent infections
Recent acute blood loss (during surgery or during child birth or post trauma
.)
Chronic illness: heart, kidney, thyroid, rheumatoid, IBD

11. Family history:

Anemia (including iron-deficiency, thalassemia, sickle cell disease ...)

Hemophilia or bleeding tendency
12. Medications: anticonvulsants, thyroid inhibitors, antipsychotics,
antiarrythmics, antirheumatics, aminosalicylates, NSAIDs

13.
14.
15.
16.

Allergic history
Psychosocial history
Occupational history
Stress