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Medical data
Please tell me about your symptoms and medical history.
What can I do for you?
Current complaints
Which parts of the body are affected?
head
neck
chest
heart
stomach
back
spine
arm
shoulder
elbow
hand
leg
hip
knee
foot
Miscellaneous
What complaints do you have?
How long have the symptoms existed?
How did the symptoms develop?
less
constant
stronger
How severe are your symptoms?
0-none
1
2
3
4
5
6
7
8
9-maximum
Have the symptoms appeared before?
yes
no
-- how often have they appeared?
-- how long did they last?
Has therapy ever been attempted?
previous illnesses
Heart: e.g. constriction of the coronary arteries, heart attack, cardiac arrhythmia
Circulatory system: e.g. blood pressure: too high, too low; fainting
Vessels: e.g. circulatory disorders, varicose veins, thrombosis
Metabolism: e.g. diabetes, gout, elevated blood lipid levels, thyroid disease
Skin: e.g. neurodermatitis, psoriasis
Lung: e.g. chronic bronchitis, asthma
Stomach/intestines: e.g. heartburn, stomach ulcers, intestinal inflammation
Liver, gallbladder: e.g. liver enlargement, jaundice, gallstones, colic
Kidney/urinary bladder: e.g. kidney stones, colic, frequent bladder infections
Skeletal system: e.g. rheumatism, osteoporosis, broken bones, injuries
Nervous system: stroke, abnormal sensations, tremors, multiple sclerosis
Psyche: e.g. depression
Cancer
Other:
Have you already had an operation? (what, when)
Have you ever had a serious accident? (which, when)
General information
Are you currently taking any medication? (which, in which dosage)
What is your profession?
Is there currently a particularly stressful situation at work, family or otherwise?
What about the use of stimulants such as alcohol, nicotine or other drugs? (which, in which dosage)
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