ram73 on 2009-09-29
Age: Sex: Built: Occupation:
1. Do you have any strange, rare, peculiar, unusual or personal symptom, feeling or a recurring thought?
2. Write down all your marked mental symptoms taking the guidelines as suggested below:
- Deliriums, Hallucinations, Fancies or Illusions.
- Dominant emotions in your temperament ( depressed, angry, shame, jealous, absent mindedness, fickle mindedness, hurry, agreeable, arguing, moody, suspicion, others.. etc )
- Your fears and recurring dreams.
- Loss in memory if at all (names, words, streets etc.)
- Propensities ( tendency to do/think about a certain act)
3. Your response to changes in environment
- Feel worse in the morning / afternoon / evening / night.
- Feel worse in cold or hot weather / climates.
- Feel worse in stormy or calm weather.
- Feel worse in dry or damp weather.
- Feel worse in motion / touch / jar / any particular position.
- Feel worse in bright light / loud sound / sharp smell etc.
4. What are your cravings and aversions in food?
5. Describe your menstrual affections ( if any )
- symptoms before / during / after
- early / late
- scanty / excessive
6. Write down the diseases running in your family.
7. Write down if you notice any abnormality with your sleep, hunger, thirst and bowel movements.
8. What are the various diseases which you have suffered from in your life and do you think your present illness is having a relation to the disease or after effects of the drugs taken during the time.
Case Taking Sheet Part - 2
PARTICULAR SYMPTOMS (Related to the parts affected in your body)
9. Do you have any strange, rare, peculiar, unusual or personal symptom, feeling or a recurring pain in the affected parts?
10. Describe your physical sufferings in the specific locations.
11. How does the suffering / pain get aggravated or ameliorated with the changing environment as suggested below:
- Time ( morning, afternoon, evening, night)
- Hot, cold, dry and wet environments.
- Touch, pressure, motion, jar, position, rubbing etc.
12. Do you think there is a specific pattern of occurance of the suffering with regard to time, period or any internal biological changes in the body?
♡ rishimba last decade
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