KEMBAR78
History Taking Format | PDF
Scribd
Upload
671 views2 pages

History Taking Format

The document outlines a standard format for taking a patient's history, including sections for identification data, chief complaint, medical history, surgical history, hereditary history, personal history, socio-economic conditions, family history, investigations, treatment, and conclusion. The format collects comprehensive information about a patient's identity, illnesses, surgeries, family medical histories, lifestyle, finances, tests, treatments, and outcomes.

Uploaded by

dipanwita karmakar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
671 views2 pages

History Taking Format

The document outlines a standard format for taking a patient's history, including sections for identification data, chief complaint, medical history, surgical history, hereditary history, personal history, socio-economic conditions, family history, investigations, treatment, and conclusion. The format collects comprehensive information about a patient's identity, illnesses, surgeries, family medical histories, lifestyle, finances, tests, treatments, and outcomes.

Uploaded by

dipanwita karmakar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

History taking format

1 . IDENTIFICATION DATA

Name Age

Sex Bed No

Ward Regd. No

Under Doctor Diagnosis

Date Of Admission Date Of Surgery

Name Of The Surgery Date Of Discharge

2. CHIEF COMPLAIN ON ADMISSION: (With Onset And Duration Of Illness)

3. PRESENT COMPLAIN:

4. MEDICAL HISTORY:

PAST-

PRESENT-

5. SURGICAL HISTORY:

PAST-

PRESENT-

6. HEREDITARY HISTORY:
7. PERSONAL HISTORY:

Blood Group History Of Previous Blood Transfusion:

Allergic History: Addiction:

Personal Hygiene: Spiritual Habit

8. SOCIO-ECONOMIC CONDITION:

Type Of House: Ventilation

Drainage System : Electricity:

Drinking Water Supply: Sanitary System:

9. FAMILY HISTORY:

S/ Name Age Sex Relation Occupatio Incom Marital Any Disease Remarks And
Ln n e Status Treatment
o

10. INVESTIGATIONS:

S/ Name Of The Date Patient’s Value Normal Value Remarks


L Investigation
No

11. TREATMENT:

12. CONCLUSION:

You might also like