1. Introduce myself (hello, my name is ……, and I am nursing student.

(Shake hands)
2. What is your name?
3. Do you want me to adject the lighting or the temperature for you?
4. I am going to interview you so I can collect data for your care plan.
5. This will take 10-20 minutes.
6. Do you have any other plans at this time?
7. I must ask you if it’s okay to write down the data you gave me on pepper?
8. To be clear, this conversation will stay between you and me and will discuses it only with
your assigned doctor.
9. How old are you?
10. What do you do for living?
11. What brings you here?
12. What makes it worst or when do you experience it mostly?
13. What makes it better?
14. Can you describe how it feels in more details?
15. Where do you feel it mostly, in which part of your body?
16. Does it speared to any other part of your body?
17. Since when have you been feeling like this?
18. Is it painful?
19. If I draw you a scale from 0 to 10, 0 means no pain, 5 means there is pain but you can
bare it and 10 means unbearable pain.
20. Do you have any history/problems related to your respiratory system?
21. Do you have any history/problems related to your cardiovascular system?
22. Do you experience anything that makes you distressed?
23. Do you have any family member that have experienced the same thing?
24. Sorry, to ask you this but do you smoke?
25. Does any of your family member smoke?
26. Did you visit the health center before?
27. Have you done x-rays before?
28. Sorry to ask you this but do you have history of cancer or tuberculosis?
29. Have you done any surgeries before?
30. Do you have any allergy?
31. Con you describe your sleeping pattern for me?
32. Have you been experiencing any alteration regarding your appetite recently?
33. How does the episodes or attacks affect your daily routine?

Summery:
(Two sentences about the chief complain.)

34. Do you have anything else to add?

35. Do you have any questions?