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  • Aroghyam Kshetra Patient History

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    RAHUL
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    AROGHYAM KSHETRA PATIENT HISTORY

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    2 views1 page

    Aroghyam Kshetra Patient History

    Uploaded by

    RAHUL

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    AROGHYAM KSHETRA

    B.BORKAR ROAD, H.NO 688, ALTO PORVORIM, GOA - Ph: 9632520716

    Name:________________ Phone:___________________Address:_________________Date:_______________

    Chief Complaint:______________________________________________________________________________

    Problems List: 1)_________________ 2)__________________ 3)________________ 4)_____________________

    Medications: ____________________________________ Past Surgeries:________________________________

    Allergies:_______________________ Past Treatments/Hospitalizations:_________________________________

    Blood Test/Scans:_____________________________________________________________________________

    TCM History: Pains:___________________Swelling___________


    Taste:___________ Heat/Cold___ Energy:__________Sweating:

    ____________Stools:___________Urine:__________________
    Phlegm:____________Sleep:_____________Exercise::________
    Emotions:_______________Constitution:________________

    Menstrual History : Pregnancy: Y/N LMP:__________ MP:____

    DIAGNOSES:

    TREATMENT:

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