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Edit
[Edited by Zees on 2022-05-18 18:41:44]
 
  Zees on 2020-10-14
This is just a forum. Assume posts are not from medical professionals.
fill this


Age :                                                Date of Birth :                             Sex :                        Wt.:
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.
·         Side.
·         Location & Extension
·         Character of Pain.
·         Duration of Pain.
·         Sensation.
·         Modalities : Movements/ Positions/ Thermals/ Food Habits/ Seasonal/
                                      Time
¾     Concomitant.
Complain 1
 
 
2
 
 
3
 
4

5

6

7

Etc
 
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.
·         Bladder:
·         Skin :
·         Chest & Back :
·         Extremities:
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   Covering
o   Bed+ Pillow
o   Talking/ Walking sleep during?
o   Eyes open / closed sleep during.
·         Dreams :
·         Female:
o   Menstrual History
i.                     Menarche
ii.                   Duration of cycle
iii.                  Color of discharge/ Any clots, etc.
iv.                 Smell
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.
o Ambition.
 
·         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   Consolation.
o   Hobbies?
o   About Social Activities.
o   Lazy/ Workaholic.
o   Industrious ?
o   Duty Bound?
o   Relation with others :
¾     Husband/ Wife
¾     Son / Daughter.
¾     In-laws.
¾     Friends.
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   Perfectionism.
o   Fall/ Accident/ Injury/ Fracture/ Sprain/ Loss of fluid.
o   Overexertion.
o   Brooding.
o   Suppression of anger.
o   Any major setback in life.
Your Observation(Physical Appearance/Dressing).
Thermals :
                                    Summer                                          Winter
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
Edit
[Edited by Zees on 2022-05-18 18:42:10]
 
Zees last year
We will go gently in order to heal you
First you start

China 30
4 drops twice a day for 10 days

Report me after 10 days


Dr.Jitesh Sharma
 
drjitesh last year
Thank you very much Doctor for you advise. I will start the remedy and update you in 10 days as per your guidance.

Can't thank you enough for helping me...
 
Zees last year
Edit
[Edited by Zees on 2022-05-18 18:42:48]
 
Zees last year
Just to highlight the post and keep it visible in the forum
[Edited by Zees on 2020-10-31 14:05:57]
 
Zees last year
Dear Dr Jitesh

May I please know if you have any online consultation available in India?

Thank you
 
Zees last year
WE DO HAVE ONLINE CONSULTATION

CHECK MY PROFILE FOR DETAILS & EMAIL

DR.JITESH SHARMA
 
drjitesh last year
click dr.jitesh name to see info.
Clicking any user name will show info they provide.it will also show past threads and current threads.
 
simone717 last year
Edit
[Edited by Zees on 2022-05-18 18:42:21]
 
Zees last year

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Information given in this forum is given by way of exchange of views only, and those views are not necessarily those of ABC Homeopathy. It is not to be treated as a medical diagnosis or prescription, and should not be used as a substitute for a consultation with a qualified homeopath or physician. It is possible that advice given here may be dangerous, and you should make your own checks that it is safe. If symptoms persist, seek professional medical attention. Bear in mind that even minor symptoms can be a sign of a more serious underlying condition, and a timely diagnosis by your doctor could save your life.