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REVIEW OF SYMPTOMS

GENERAL: Fever, chills, night sweats, weight loss/gain

HEENT: Headache, dizziness, fainting, change in eyesight, hearing, voice, mouth/throat pain, lumps/masses

SKIN: Rashes, sores, change in hair/nails, change in size/color of moles

BREASTS: Tenderness, lumps, nipple change/discharge

RESPIRATORY: Cough, shortness of breath, wheezing or blood in cough

CARDIAC: Chest pain, palpitations, shortness of breath w/exertion, swelling ankles

GI: Difficulty swallowing, abdominal pain, nausea, vomiting, diarrhea, constipation, blood/mucous in stool

GU: (MEN) Blood in urine, nocturia, trouble starting urine/stopping urine, erection difficulty

GU: (WOMEN) Irregular/abnormal bleeding, pain, vaginal discharge, burning/blood in urine

MUSCULOSKELETAL: Bone/joint stiffness, pain, swelling/tenderness, limitation of motion, muscle weakness, tenderness
or difficulty walking

NEURO: Headache, confusion, forgetfulness, double vision, weakness in arm/leg, trouble w/coordination, burning,
numbness

PSYCH: Excessive worry, nervousness, depression, seeing/hearing things that aren’t there

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