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    History Taking Guide

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    Jo Marchianne Pigar
    The document contains a template for collecting a patient's demographic information, obstetric history, psychosocial history, family health history, past medical history, and vital signs. It includes fields for the patient's name, address, religion, birth date, education, and occupation as well as medical information like pregnancy history, illnesses, surgeries, and current symptoms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    History Taking Guide

    Uploaded by

    Jo Marchianne Pigar
    37 views2 pages
    The document contains a template for collecting a patient's demographic information, obstetric history, psychosocial history, family health history, past medical history, and vital signs. It includes fields for the patient's name, address, religion, birth date, education, and occupation as well as medical information like pregnancy history, illnesses, surgeries, and current symptoms.

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    guide

    Original Title

    History taking guide

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    The document contains a template for collecting a patient's demographic information, obstetric history, psychosocial history, family health history, past medical history, and vital signs. It includes fields for the patient's name, address, religion, birth date, education, and occupation as well as medical information like pregnancy history, illnesses, surgeries, and current symptoms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    37 views2 pages

    History Taking Guide

    Uploaded by

    Jo Marchianne Pigar
    The document contains a template for collecting a patient's demographic information, obstetric history, psychosocial history, family health history, past medical history, and vital signs. It includes fields for the patient's name, address, religion, birth date, education, and occupation as well as medical information like pregnancy history, illnesses, surgeries, and current symptoms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    DOÑA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION, INC.

    COLLEGE OF NURSING
    . 1st Semester, S.Y. 2019-2020

    Name of Student: Clinical Group:


    Date: Clinical Instructor:
    I. DEMOGRAPHIC DATA
    Name of Client: I. Religion:
    Date interviewed: II. Newborn’s Name:
    Age: III. Civil Status:
    Date of Birth of mother: IV. Gender:
    Address:
    V. Educational Attainment:
    Occupation:
    VI. Birth Date:
    II. OBSTETRIC HISTORY
    G__ T__ P__ A__ L__ M__
    LMP:
    EDD:
    Age of menarche:
    Amount of flow:
    Pain:
    Contraceptive History:
    III. PSYCHOSOCIAL/ PERSONAL HEALTH HISTORY
    Smoking habits:
    Alcohol drinking:
    Medication taken, if any:
    Exercises:
    Relaxation:
    IV. FAMILY HEALTH HISTORY
    Check occurrence of the following diseases in the family
     Diabetes Meletus
     Pulmonary Tuberculosis
     Nero-muscular Disease
     Renal Disease
     Cardiac Disease
     Complications of Pregnancy/ Congenital anomalies
     Psychiatric Disorder
     Urinary Tract Infection
     Hypertension
     Allergies
     Others:_________________________________
    V. PAST MEDICAL HISTORY
    Birth Problems:
    Childhood Illness:
    Immunizations:
    Present Illness:
    Past Surgeries/ Hospitalization:
    Allergies:

    VI. VITAL SIGNS:


    TIME
    TEMPERATURE
    BLOOD PRESSURE
    RESPIRATORY RATE

    PULSE RATE
    DOÑA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION, INC.
    COLLEGE OF NURSING
    . 1st Semester, S.Y. 2019-2020

    Name of Student: Clinical Group:


    Date: Clinical Instructor:
    I. DEMOGRAPHIC DATA
    Name of Client: VII. Religion:
    Date interviewed: VIII. Newborn’s
    Age: Name:
    Date of Birth of mother: IX. Civil Status:
    Address: X. Gender:
    Occupation:
    XI. Educational Attainment:
    VI. OBSTETRIC HISTORY XII. Birth Date:
    G__ T__ P__ A__ L__ M__
    LMP:
    EDD:
    Age of menarche:
    Amount of flow:
    Pain:
    Contraceptive History:
    VII. PSYCHOSOCIAL/ PERSONAL HEALTH HISTORY
    Smoking habits:
    Alcohol drinking:
    Medication taken, if any:
    Exercises:
    Relaxation:
    VIII. FAMILY HEALTH HISTORY
    Check occurrence of the following diseases in the family
     Diabetes Meletus
     Pulmonary Tuberculosis
     Nero-muscular Disease
     Renal Disease
     Cardiac Disease
     Complications of Pregnancy/ Congenital anomalies
     Psychiatric Disorder
     Urinary Tract Infection
     Hypertension
     Allergies
     Others:_________________________________
    IX. PAST MEDICAL HISTORY
    Birth Problems:
    Childhood Illness:
    Immunizations:
    Present Illness:
    Past Surgeries/ Hospitalization:
    Allergies:

    VI. VITAL SIGNS:


    TIME
    TEMPERATURE
    BLOOD PRESSURE
    RESPIRATORY RATE

    PULSE RATE

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