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General Fatigue Itching Gastrointestinal No swallowing difficulties,

Weakness hay fever heartburn, change in


Fever nosebleed appetite, anorexia. No
Chills stuffiness nausea or vomiting. No
weight loss/gain sinus pain change in bowel habits,
delay in growth o Mouth bleeding rectal bleeding,
change in activity level and sore tongue constipation, diarrhea. No
Skin Dryness Throat dry mouth food intolerance. No
Lumps dysphagia abdominal pain, bloating
Pallor odynophagia or pica.
Rashes sore throat Genito-Urinary With enuresis. No
Itching hoarseness increased frequency,
acne thrush urgency, burning or pain
jaundice non-healing sores on urination. No change in
hair and nail changes toothache urinary strength, urine
HEENT dental carries color or hematuria. No
o Head Headache dental check up edema of the hands and
Dizziness Neck No lumps, swollen glands, feet. No prepubertal
history of head injury pain, stiffness. discharge and itching.
o Eyes Redness Breasts No lumps, pain, discharge, Peripheral No calf pain with walking,
vision loss or changes discomfort. Vascular leg cramping, stasis
use glasses Respiratory With cough, sputum pigmentation.
crossed eye production, shortness of Musculoskeletal No muscle or joint pain,
pain breath and difficulty of redness, stiffness, back
blurring or doubling of breathing. No hemoptysis, pain. No swelling of
vision wheezing, painful joints. No weakness. No
flashing of lights, specks breathing. history of trauma,
dryness Cardiovascular Easy fatigability. No chest limping, limitation of
lacrimation pain, discomfort or motion.
o Ears decreased hearing tightness. No Neurologic No fainting, seizures,
tinnitus palpitations. No weakness, numbness. No
earache orthopnea, dyspnea. No tingling sensation,
discharge. cyanosis. tremor, paralysis or
o Nose Discharge
sensory loss. No memory Endocrine Profuse sweating even at Ambulatory, hyposthenic,
loss. rest. No heat or cold well-groomed and dressed
Psychiatric No trouble sleeping, intolerance. No frequent appropriately for the
nervousness, stress. No urination. No polydipsia, weather.
depression. No eating polyuria, polyphagia. No Vital Signs Temperature:
problems. No personality palpitation. Heart Rate:
or behavioral changes, General Survey Conscious Respiratory Rate:
temper outbursts, Alert Blood Pressure:
hallucinations. Anxious Oxygen Saturation:
Hematologic No pallor, jaundice, easy Irritable Anthropometrics Height:
bruising, bleeding cardiopulmonary distress, Weight:
tendencies. No history of uncooperative, connected BMI:
blood transfusions. to an IV fluid line.