Ideal56 on 2020-10-07
Address : (in detail)
Blood Group: Ph: E-mail :
__________________________________________________________________________________A. K/C/O : [Duration is important. e.g. HTN since 2 yrs. etc.]
B. Investigations :
Date : Haemogram / Blood Report/ Urine Report/ CT scan/ MRI/USG Abdomen & Pelvis/ Thyroid Function Test, etc.
C. Chief C/O: Write the complaints with sides & duration.
Give them separate nos. [e.g. 1] Abdominal pain(Rt. side)Since 8 days. Etc.
Please start with History of C/C : How complaints started?
H/o C/C : Write every complaint individually with-
· Onset, decline, causation.
· Location & Extension
· Character of Pain.
· Duration of Pain.
· Modalities : Movements/ Positions/ Thermals/ Food Habits/ Seasonal/
D. Ask for any recurrent complaint. Ex. Fever, Cold, Coryza.
E. Past H/o : Any major illness (along with side if present) e.g. H/o Typhoid/ Malaria / Jaundice/
Fracture/ Fall/ Injury/ Accident.
And H/o Vaccination – Hepatitis B / Dog bite Vaccination, etc.
Blood Group :
F. Family H/o
G. Physical Generals :
· Habit : Alcohol / Drugs/ Smoking/ Tobacco, etc. (Since how many tears?)
· Diet : Veg./ Mixed.
· Appetite : Any alteration?
Whether patient can tolerate hunger?
· Desire : With reference to taste and not any particular food item. e.g. Sweet, Pungent, Spicy,
Sour, Fatty(Oily, ghee), Non- veg, milk, milk products, tea, coffee, Vegetables, Fruits, Ice Cream, Cold Drinks etc. is important. Also ask for any desire for indigestible food items.
· Aversion : Main taste e.g. Sweet, Sour, Fatty, Non-veg etc. is also important.
· Food :
· Head :
· Eyes :
· Ears :
· Nose :
· Mouth : any odour
· Tongue : Dry/Moist/ Coating/ Cracked/ Fissured/ Imprints of teeth
· Thirst : Thirsty/ S.Q.S.I./L.Q.S.I./Thirstless.
· Teeth : Carries of teeth.
· Gums : Bleeding Gums.
· Taste : Any particular taste in mouth
· Throat :
· Chest :
· Stomach/ Abdomen :
· Bowel : Character of stool is important. Dry/ Hard/ Soft/ Loose. Color, Smell, Straining or not? Etc.
· Skin :
· Chest & Back :
o Upper Extremities:
o Lower Extremities :
· Perspiration :
o Scanty/ Profuse. On which part of the body?
o Stain /Odour.
o Hot/ Cold sweating.
· Sleep :
o Time : Daytime any sleeping habit / Night time sleep hrs.
o Sound/ Natural
o Refreshing/ Unrefreshing
o Startles/ Snoring
o Position : Whether lies on back / sides-which side ?
o Bed+ Pillow
o Talking/ Walking sleep during?
o Eyes open / closed sleep during.
· Dreams :
o Menstrual History
ii. Duration of cycle
iii. Color of discharge/ Any clots, etc.
v. Any pain Before / During etc.
· In General Discharges : Color/ Smell/ Quantity –scanty/ profuse etc. (very important)
H. Mind :
· Education :
· Occupation : (Working / Retired)
· Childhood at which place? –City/ Town
· Marital Status : Married / Unmarried
· Childhood :
o Family : Joint / Separate
o Financial Condition : Sound/ Poor/ Rich etc.
o About Study:
o Nature : Obstinate/ Mild/ Pampered/ Short Tempered/ Irritable.
o Desires Company or Not?
o Close to?
o Fear of/ Stage courage
o Playful/ Studious.
o Any impactful/ disturbing incidence in childhood.
o Angry when? How is it expressed ?
o Timid / Daring.
· After Marriage.
(Suppression injustice and relation with inlaws, Adjustment)
· NOW :
o Specially ask about main feelings : Anger, Sadness, Hypocrisy, Jealousy, etc. (Please, write in Rubric form)
o Family: Joint / Separate
o Financial Condition : Sound / Poor/ Rich etc.
o Mild/ Short Tempered
o Angry when ? How is it expressed?
o Talkative/ Less talkative.
o Jolly- Jesting/ Submissive
o Affectionate / Reserved/ Censorious.
o Reaction to Jesting
o Reaction to Criticism.
o Reaction to Reprimand
o Reaction to Mortification
o Any major conflicts
o Sympathy about ?
o Helping nature?
o Desires Company?
o About Cleanliness.
o About Time Punctuality.
o About Religiousness.
o Reaction to Lie & Injustice.
o Fears ? (Being alone, Dark, Water, Height, Quarrel, Exam, Robbers, Animals, Downward Motion)
o Sensitive (Physically & Emotionally)
o Happy When?
o Sad when?
o Weeps when?
o About Social Activities.
o Lazy/ Workaholic.
o Industrious ?
o Duty Bound?
o Relation with others :
¾ Husband/ Wife
¾ Son / Daughter.
¾ Colleagues, etc.
· A/F :
o Anxiety about what ?
Loan, Court case, Money, Future, Health, Disease, Death, Job, Settlement, Children.
o Any Anticipatory Anxiety
o Death of Relatives :
Reaction : Grief, Sad, Forsaken, Helpless, Weeping.
o Any Insecurity
o Fall/ Accident/ Injury/ Fracture/ Sprain/ Loss of fluid.
o Suppression of anger.
o Any major setback in life.
Your Observation(Physical Appearance/Dressing).
Bathing Hot / Cold / Luke Warm Hot / Cold / Luke Warm
Fanning requires or not? requires or not?
Covering Thick / Thin? (1 or 2,etc) Thick / Thin? (1 or 2,etc)
· Open air : desires or not
· Require Sweater in Winter ?
· Chills begin from which part?
♡ drjitesh last year
Dr Jitesh would have to study your entire case
And prescribe based on that.
You should talk to your homeopath for this additional problem.
♡ simone717 last year
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