1.

Introduction:
Good afternoon, my name is __________ , I am a 1 st year medical student.

Can I just confirm your name please, you are …. ?

Okay Mr…. Can I take a history from you?

Now before we begin, I just want to make sure you know that everything stays confidential here. Btw, is there anything I
can get for you? Are you comfortable, is the room temperature okay?

2. Chief Complaint:
Okay very well then, so what brings you in today Mr…. ?

I see, and about how long has this been going on for?

Alright, and is there anything else bothering you at the moment?

3. History of Present Illness :

Well then I’m just going to ask you several questions regarding this complaint.

S: Site – So where exactly did you first start feeling this pain?

O: Onset – And about how long ago would you say you started noticing this pain?

C: Character – Could you try to describe to me what kind of pain it was? Like is it more of a sharp pain or dull pain?

R: Radiation – I see, now does this pain ever spread to anywhere else on your body?

A: Associated Symptoms – Okay well then, are there any other signs or symptoms you notice that are associated with
this problem?

T: Timing – Would you say you have noticed any patterns of when you start feeling this?

E: Exacerbating/Relieving Factors – And is there anything that you do that potentially makes this pain worse? And is
there anything that you do that helps relieve it?

S: Severity – Lastly, on a scale of 1 to 10, 10 being the absolute worst, how bad would you say the pain is?

And so, just so we’re on the same page, I’m going to briefly summarize what I just heard…

4. Past Medical History:

Okay well then, I’m beginning to get an idea about what may have brought you in today. So if it’s okay with you, I’d like
to ask a few questions regarding your health in the past.

Can you tell me when the last time you saw a doctor was? And if you don’t mind me asking what that was for?

Have you ever been hospitalized before? Ever had any serious illnesses or operations?

What about any chronic illnesses, such as diabetes, high blood pressure and or asthma?
Okay well that’s good to hear. And one more thing I wanted to ask was if you have any allergies to foods or the
environment?

5. Drug History:
Thank you for that information. Next I’d like to just ask you a few questions regarding medications.

Are you currently taking any prescription medications? And if so, what’s it called and how much do you take?

And may I ask if there’s anything else that you are taking? Perhaps any over the counter medications, vitamin s or even
herbal supplements?

And I know I have asked you this before, but just to clarify, you’re not allergic to even any medications either?

6. Social History:
Okay, well that’s good to hear. Now if it’s okay with you, I’d like to hear a bit more about you in general, and remember
that all of this stays completely confidential.

Tell me about who’s at home with you?

I see, and do you work outside the house?

Do you have time for any hobbies, exercise, or any recreational sports?

What about your diet? Would you say that you eat fairly healthy? Do you potentially exclude any major food groups
from your diet, for example are you a vegetarian? And are you able to take dairy products normally?

Do you partake in drinking alcohol, and if so, tell me a little more about that?

And also what about smoking? Like do you smoke cigarettes (if so, how often)?

Lastly, what about any recreational drugs such as marijuana, cocaine or any pills?

7. Family History:
Well alright then, thank you for that information. If you can bear with me for just a little longer, I’ve almost got
everything that I need. Now I’d like to hear a bit more about your family.

Your parents – are they still living? If so, tell me about their age and health.

What about any brothers or sisters? If so, tell me about their ages and health as well.

Do you happen to have any children? If so, what’s their ages and how’s their health?

Now are there any illnesses that seem to run in your family? Like any inherited conditions such as cystic fibrosis, heart
attack or stroke? What about cancer or diabetes or even high blood pressure?

Okay well thanks again, that about almost wraps this up.

8. Review of Systems:

And now, as my last task, I’ll just be doing a quick overview of your systems if that’s okay.

Starting on top with your head, have you noticed any headaches or any problems with concentrating?
What about your vision? Any sort of pain or blurriness?

What about your ears? No trouble hearing or anything coming out from them?

What about your sense of smell? No runny noses or anything?

What about your mouth? Everything tasting okay when you eat? No problems with your tongue?

And is everything okay with your skin? Sensation of touching and everything is normal?

Okay well that’s good to hear, now moving down to your neck, any problems with rotating or moving it?

And now with your chest, have you noticed any pain within or even any shoulder pain?

No problems with breathing, such as when inhaling or exhaling?

Moving a little further down your body, recall of any pain coming from your abdomen? Any stomach pain after eating?

What about your bowel movements, are they normal? And do you have any problems when using the bathroom?

Have you noticed anything unusual in your genital area? (If a woman, ask if how her menstruations are regular, duration,
flow, and if any pain)

And just in general, have you noticed any bodily pains? Any problems with any muscle soreness, or any joint pain in your
extremities?

And hopefully for my last question for you, how are your feet? Any sort of pain or swelling in them?

9. Closure:
Well I hope I didn’t that didn’t take up too much of your time, and I would like to thank you very much for speaking with
me. If you have any questions for me, please don’t feel hesitated to ask. I will take this information to my attending
doctor, and we’ll get back to you shortly. Have a good day, it was a pleasure meeting you Mr….