Іі. Role-play and additional material

Identification

What is your full name?

What is your surname?

What is your first (Christian) name?

How old are you?

What is your nationality?

Are you married?

Are you divorced?

What do you do for a living?

Where do you work?

What post do you hold?

Are you a housewife?

Are you on pension?

Where do you live?

What is your home address?

When ere you born?

Where were you born?

CHIEF COMPLAINTS

What kind of trouble do you have?

What is the matter with you?

What is wrong with you?

What is your problem?

What ails you?

What are your complaints?

Why do you seek help?

What brought you to the hospital?

PRESENT ILLINESS

Duration

Is the trouble acute or chronic?

How long have you been ill?

When were you last well?

When did your symptoms first begin?

Was the onset of the disease sudden or slow?

Location

Where do you have pain?

Would you show with your finger the place where it hurts you?

Does the pain remain localized, or does it travel or radiate to some other region?

Progress

Has the trouble developed rapidly or slowly?

Have the symptoms become worse or better?

Are they better at times and worse at others?

Character

Is the pain sharp or dull?

Is it really pain or is it discomfort?

Does the pain appear suddenly and disappear quickly?

Does the pain gradually increase in intensity and slowly subside?

Relation to Physiologic Function

What is the effect of posture upon the symptoms?

Are the symptoms worse when you are standing, sitting or lying down?

What effect does exercise produce?

Are the symptoms worse when you walk?

Does eating relieve the symptoms or aggravate them?

Does sleep bring relief?

Do symptoms wake you from a sound sleep?

Effects of Disease

Have you been treated for your ailment and what was the treatment?

What was the opinion of other physicians?

Have you become weak and lost weight?

Did you ever have any fever, chills or sweats lately?

PAST ILLNESSES

Diseases of Childhood

What childhood diseases did you have?

Did you ever have measles? Chicken-pox? Whooping cough?

German measles?

As a child, did you have rheumatic fever, growing pains or twitching of the limbs?

Serious Illnesses

Have you ever been sick before?

What kind of sickness did you have in the past?

Did you ever have scarlet fever?

Did you ever have malaria?

Were you ever treated for severe anemia (thin blood)?

Were you ever treated for “bad blood” (venereal disease)?

Do you have diabetes (sugar disease)?

Did a doctor ever say you had a goiter?

Did a doctor ever treat you for tumor or cancer?

Do you suffer from any chronic disease?

Did a doctor ever say you had varicose veins (swollen veins) in your legs?