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ROS Checklist
ROS Checklist
Constitutional = General + VITALS: BP: Pt. perception of health Change in sleep Night sweats Fever or Chills HEENT: Head: Frequent or unusual headaches Location Dizziness Syncope Severe head injuries Loss of consciousness Momentary or prolonged Eyes: Use of glasses/contacts Visual acuity Change in appearance/ specks /blind spots? Change in vision Blurring Double vision Light sensitivity / flashing lights? Pain Tearing? Use of eye drops or other medication History of trauma Glaucoma or familial eye disease cataracts Ears: Hearing loss Frequent infections / Ear ache? Pain Discharge Tinnitus Vertigo Nose: Altered smell Frequent colds / stuffiness Obstruction Nosebleeds Postnasal drip / discharge Sinus pain Throat and mouth: Hoarseness Change in voice Frequent sore throat Bleeding or swelling of gums Tooth abscess or loss / dentures Non-healing sores / ulcers Thrush Altered taste Snoring and or snoring partner MAM: 6-28-05 JDE: Rev. 07-14-2012 / , HR b/m, Resp: ,Temp: F, Ht: Strength or Weakness Energy level? Easily fatigued? Exercise tolerance Ability conduct usual activities Thirst & Appetite Wt: lbs/ k, BMI: Weight loss or gain Average lbs. Preferred Change lbs. lbs.
Neck: Neck pain FROM? Or stiffness Lumps / thyroid enlargement LAD JVD Respiratory & Chest: Respiratory pain Dyspnea SOB Wheezing or stridor Cough what time of day Sputum Color and quantity Hemoptysis Fever or night sweats Exposure to tuberculosis Clubbing of fingers Cyanosis Last CXR Cardiovascular Heart: Precordial pain or substernal distress Precipitating causes Timing and duration Relieving factors Tightness Palpitations Syncope Dyspnea on exertion (DOE) Paroxysmal nocturnal dyspnea (PND) Orthopnea w/ Number of pillows Edema Claudicating Cyanosis HTN Hx of murmurs Previous myocardial infarction Exercise tolerance Past cardiac tests Blood Vessels: Claudication / calf pain w/ walking Leg cramping Varicose veins Thrombophlebitis Thrombosis Page 1
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