R.V.

S HOMOEOPATHY MEDICAL COLLEGE & HOSPITAL

SULUR, COIMBATORE-641402
CASE RECORD

DATE: REG.NO:

UNIT: UNIT HEAD:

PRIMARY PHYSICIAN:

NAME :

AGE: SEX: RELIGION:

OCCUPATION:

ADDRESS:

TELEPHONE/MOBILE:

DIAGNOSIS:

PRESENTING COMPLAINTS:
 LOCATION SENSATION& MODALITIES CONCOMITANTS
S.NO
PATHOLOGY
HISTORY OF PRESENTING ILLNESS:

(Origin, duration and progress of each symptom in chronological order along with its mode of
onset, probable cause, details of treatment and their outcome)
PAST HISTORY AND TREATMENT HISTORY WITH OUTCOME (INCLUDING
SURGICAL HISTORY):

FAMILY HISTORY:

PHYSICAL GENERALS:
APPETITE:
THIRST:
DESIRES:
AVERSIONS:
INTOLERANCE:
BLADDER HABITS:
BOWEL HABITS:
PERSPIRATION:
SLEEP:
DREAMS:
THERMAL STATE:
MENSES:
MENARCHE: LMP:
CYCLE:

COMPLAINTS-MENSES BEFORE DURING AFTER

LEUCORRHOEA:

CHANGES IN MENSTRUAL CYCLE, HISTORY OF GYNAECOLOGICAL SURGERIES:

OBSTETRICAL HISTORY:

LIFE SPACE INVESTIGATION:

MENTAL GENERALS:
GENERAL PHYSICAL EXAMINATION:
CONSCIOUSNESS: ORIENTATION:
APPEARANCE: BUILT:
NOURISHMENT: GAIT:

PALLOR: CYANOSIS: CLUBBING:

JAUNDICE: OEDEMA: LYMPHADENOPATHY:
VITAL SIGNS:
PULSE: RESPIRATORY RATE:
BLOOD PRESSURE: TEMPERATURE:
HEIGHT: Cms WEIGHT: kgs BMI:

SYSTEMIC EXAMINATION:
SYSTEM RELATED TO CHIEF COMPLAINT:

OTHER SYSTEMS:
LAB INVESTIGATIONS:

PROVISIONAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS

HOMOEOPATHIC DIAGNOSIS ACCORDING TO HAHNEMANN’S
CLASSIFICATION OF DISEASE:

ANALYSIS OF CASE

COMMON SYMPTOMS UNCOMMON SYMPTOMS

TOTALITY OF SYMPTOMS
CHRONIC TOTALITY:

ACUTE/SECTOR TOTALITY:
MIASMATIC DIAGNOSIS:

S.NO PSORA SYCOSIS TUBERCULAR SYPHILIS

FUNDAMENTAL MIASM:

DOMINANT MIASM:
SELECTION OF MEDICINE:
REPERTORIAL APPROACH (MENTION SYMPTOMS, RUBRICS, EXPLANATION, PAGE NO,
REPERTORIAL RESULT, PDF AND ANALYSIS):

REMEDY DIAGNOSIS WITH REASONS:

REASON FOR SELECTION OF POTENCY, DOSAGE AND REPETITION:

S.NO CRITERIA INTERPRETATION POTENCY REPETATION

1 SUSCEPTIBILITY

2 SENSITIVITY

3 SUPPRESSIONS

4 CORRESPONDENCE

5 FUNCTIONAL
CHANGES

6 STRUCTURAL
CHANGES

7 MIASM

POTENCY CHOICE:

REPETITION:

GENERAL MANAGEMENT AND AUXILIARY MEASURES

PRESCRIPTION:

FOLLOWUP CRITERIA: