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  • My e Konsulta HX PE Form

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    jejeje lo
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    My e Konsulta Hx PE Form

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    © All Rights Reserved
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    Download as doc, pdf, or txt
    1 views2 pages

    My e Konsulta HX PE Form

    Uploaded by

    jejeje lo

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 2

    Date

    Informant
    Reliability

    Gen data

    Chief complaint

    HPI

    Past medical history


    Medical: HPN, DM, Asthma, CA, Heart disease, PTB, Allergy
    Others:
    Psych:
    Surgical:

    Family History
    Medical: HPN, DM, Asthma, CA, Heart disease, PTB, Allergy
    Psych
    Surgical

    Personal and social History


    Occupational/education:
    Travel History:
    Exposure (allergen, factory, poisoning)
    Alcohol use:
    Diet:
    Smoking:
    Pack years:

    OB/GYN
    Menarche
    Interval
    Duration
    Amount
    S/s others:
    ROS:

    Physical Exam

    Neurologic Exam

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