Site
Localised / generalised, unilateral / bilateral
Onset
Sudden / gradual, situation, following trauma
Character
Sharp, dull, burning, tightness
Radiation
E.g. down the arm, across the back
Associations
Any other symptoms e.g. shortness of breath, nausea / vomiting
Timing
Duration, frequency, changes through the day, constant / fluctuant / episodic
Exacerbating & Alleviating Factors
Exertion / rest, medications, movement, breathing, eating, stress
Severity
On a scale of 1-10, with 10 being the worst
Medical Conditions
Diagnosis, severity, management, follow up, impact
Specific Conditions
Diabetes, asthma, high BP, heart disease, cancer
Past Surgery
When, where, which doctor
Current Medications
Indication, dose, taking for how long
Vitamins / Supplements
Alternative Medicines
Herbs, homeopathic remedies
Vaccinations
Up to date?
Conditions In the Family
Heart disease, cancer, diabetes, autoimmune Dx
Living Family Members
Health, age, any medical conditions
Deceased Family Members
Age at death, cause of death
Recent Travel
Especially to developing countries
Family
Relationship status, children
Relationship Status
Single / de facto / married / separated / divorced
Children
How many children, how old
Living Situation
Where, who they live with, low or highset
Vocation
Education, occupation, source of income
Education
Level of education attained
Occupation
Current job, past jobs, level of activity, toxin exposure
Source of Income
Occupation / pension / worker's compensation
Hobbies
Diet
On an average day
Exercise
Time spent exercising, type of exercise, tolerance
Mobility
Aids, transfers, number of stairs in home, mods
Activities of Daily Living
Cooking, cleaning, laundry, toileting, shopping
Who does what, any assistance with these
Degree of Support Available
Physically and psychologically
Impact of Presenting Complaint
On relationships, work etc.