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  • Case Template (Urology & Nephrology)

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    Huda
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    This document appears to be a case sheet from a medical university hospital for documenting information about a patient. It includes sections for the patient's name, age, gender, occupation, date of admission, chief complaint, history of present illness, review of major body systems, drug history, past medical history, past surgical history, family history, socioeconomic history, vital signs, and notes from the physical examination.

    Original Description:

    Original Title

    Case Template (Urology & Nephrology) (1)

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    This document appears to be a case sheet from a medical university hospital for documenting information about a patient. It includes sections for the patient's name, age, gender, occupation, date of admission, chief complaint, history of present illness, review of major body systems, drug history, past medical history, past surgical history, family history, socioeconomic history, vital signs, and notes from the physical examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    35 views3 pages

    Case Template (Urology & Nephrology)

    Uploaded by

    Huda
    This document appears to be a case sheet from a medical university hospital for documenting information about a patient. It includes sections for the patient's name, age, gender, occupation, date of admission, chief complaint, history of present illness, review of major body systems, drug history, past medical history, past surgical history, family history, socioeconomic history, vital signs, and notes from the physical examination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 3

    Hawler Medical University/

    College of Medicine/

    Department of Medicine.

    Case Sheet No:

    Date:

    Patient Name: Age:

    Gender: &'()*'+ ,*'*#$

    !""#$%%&

    Occupation:

    Date of Admission:

    History of Chief complain & duration:-----------------------------------------------------------------------------------

    History of present illness:

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    Systemic Review:

    Skin: _________________________________________________________________________

    Cardiovascular System: ____________________________________________________________

    Respiratory System: _______________________________________________________________

    GIT System: ______________________________________________________________________

    GUT system: _____________________________________________________________________

    Musculoskeletal System: ___________________________________________________________

    Psychiatric: ______________________________________________________________________

    Drug history

    Past Medical History:


    :
    Condition: Medications:
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________

    Past surgical history:

    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________

    Family History:
    ________________________________________________________________________________
    ________________________________________________________________________________

    Socioeconomic History:
    :
    ________________________________________________________________________________
    ________________________________________________________________________________

    Physical Examinations:

    Vital signs PR: RR : BP: Temp: Spo2:

    General:

    ________

    _______________________________________________________________________________

    _______________________________________________________________________________

    _______________________________________________________________________________

    ________________________________________________________________________________

    ________________________________________________________________________________

    ______________________________________________________________________________

    _______________________________________________________________________________
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!! !!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!! !!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!! !!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    ______________________________________________________________________________

    _________________________________________________________________________________

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