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The ABC Homeopathy Forum

Case-Taking-Format

any doctor send me a complete Case-Taking-Format with thanks
 
  alrahim on 2006-08-01
This is just a forum. Assume posts are not from medical professionals.
Questionnaire for Taking the Case.

Please indicate a normal condition of health by writing ’N’.
1. A moderately experienced pain, by putting one plus (+); a severe one by two pluses (++), and a very severe one by three pluses (+++).
2. Where two opposite conditions are given together (e.g. tall/short), strike off the one which is not applicable.
3. Put a cross(x) against questions not applicable to the patient.
Date.
Name; ----------------------------------------------------------------------.
Sex; M/F. --------------------------------------------------------------------
Occupation. -----------------------------------------------------------------
Address. ---------------------------------------------------------------------
Married/Unmarried. -------------------------------------------------------
Height: Tall/Medium/Short.
Build: Thin/Normal/Obese.-----------------------------------------------
Age. -------------------------------------------------------------------------


A. (A) Please state briefly the serious complaints the patient has suffered from since childhood.
B. Nature of complaint. Year of occurrence. How long did it lost. Any recurrence thereafter.
C. Any history of Asthma, T.B, Cancer, Psoriasis, Insanity or any other disease.

2. Present (Chief) Complaint. Please state all the disorders patient has latterly suffered from---even if he considers any of them unimportant, or not related to his main complaint.

Part of the body affected.

Sensations and complaints.

Modalities. Aggravation/Amelioration.

Probable cause.

3. Any disorder of senses of Taste/Smell/Hearing/Vision/Touch.-----------------

Appetite/Hunger; is it normal? ---Excessive? ----Deficient------, Capricious (At unusual time)? ----- (Waiting).

Does he feel filled up after a few morsels of food---------------Abdomen bloated---------Flatulence (Gas)/------Heartburn/-------Eructation.----------

©.Food items for which patient has a craving of aversions and which disagree with him.

Food Items. Cravings. Aversion. Disagree.
Sweets.
Salty things.
Sour things.
Milk.
Eggs.
Meat/Fish.
Butter.
Spices(Condiments)
Potatoes/Starchy food.

Fried things.
Drinks, Warm/Cold.
Drinks, ice cold.
Onion/Garlic.
Raw vegetables.
Juicy, refreshing things.
Alcoholic Liquors.

ANY OTHER.

Thirst. Please indicate the intensity of his thirst with suitable ticks.

Thirsty (Drinks a lot in a day).

Thirst less (Drinks comparatively little in a day):

Quantity and frequency: Thirst for large/small quantity and at long/shorts intervals.
Stools. Please indicate severity with plus marks:

Nature of stools. Soft, Hard, Bloody, Slimy, with urging, Must strain, No of stools.

Normal,
Constipated.
Loose.
Dysenteric.

Piles.

Bleeding; ----Blind; ----Protruding; -----itching----Burning, -----Fissures, ----Painful, ----Fistula.

Aggravated by; -----------Ameliorated.

Urine.

Profuse/scanty; ----Frequent, -----Dribbling, -----Burning, -----Involuntary—Day/Night,
Colour, odour, painful, deposits, sugar, stones (Kidney/Bladder).
Position in which urine passes easily.

Breathing.
Any complaints: ------
Bronchitis; Asthma, Rapid, Oppressed, Rattling, Wheezing,
Difficult Expiration/inspiration.

Cough.
Hollow/Harassing/Tickling/Spasmodic.Dry,loose.

Expectoration.
Taste, Odour, copious/little., watery, Tenacious.

Sexual. Male.

Desire: strong/weak.
Erection.Strong/weak
Emission. In sleep, during stool/too early.
Coition, any complaint during, or after.
History of venereal diseases.

Female.
Age at first menstruation. ------.
Menses.
Profuse/scanty: Too early/Too late.
Flow.
Red/Dark/Pitch like/Smell Fetid.Any other.
Nature of the complaint in relation to menses.
Before menses/During Menses/After Menses.

Leucorrhoea.
Watery/Thick/Tenacious/Fetid smell/Acrid? Excoriating/Any other.
Causes Itching.
Abortion if any.
During which month of pregnancy.
Coition: Aversion to.Desire, Strong/Weak.
Number of children: ----Sterility.

Side of the body Affected.
(Please name the anatomical region, also stating right or left side of the body)
Complaints first appeared in ------Right/Left.
Complaints then extended to-------Right/Left from.
Complaints shift from place to another.

Cold or Hot (Burning) Sensation.
Cold/Hot (Burning in:Vertex/Eyes/ears/Face/Stomach/Abdomen/Back/Palm/Soles.Any other.

Sweat. If excessive.
Where/When/Odor of sweat/Does it stain clothes/Color of the stain.
Very little sweat (Dry skin)
Partial Sweat on; Head/Face/Soles or others.

Skin, Glands/Bones.
Nature of disease.Where/Dry/Oozing/Itching/Moist/Watery/Viscid/Bloody/Pus/Burning.

Sleep.
Normal/Sound/Disturbed/Difficult/Too sleepy/Sleeplessness/Unreflecting.

Position in sleep.
Lies on back/on right/left./lies on abdomen/Head rose.
Dreams.Pleasent/Unpleasent/Nightmare/Snoring.
Modalities.
At which time the complaint is aggravated/Ameliorated.
Under what circumstances the complaint is aggravated/Ameliorated.
In what season the complaint the complaint is aggravated/amelioration.

Mental attitude.
Sensations.
Ball or plug/burning/heat/benumbing/bruished/bursting/splitting/chilly/cramps/constricting/contracting/dizziness/vertigo/emptiness/fullness/itching internally/tingling/lethargy/itching/scratching/hammering/neuralgic/hammering/numbness/restlessness/scraping/sinking feeling/jerking/twitching/stiffness/rigidity/stinging/sprained/dislocated/throbbing/pulsating/trembling/quivering/tightness/tension./any other.

Any other complaint. Please write in detail.
 
sajjadakram635 last decade

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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.