FA DAVIS Gender Dysporia Patient Chart

I. Health History: Results of the Patient Interview Biographic Data (age, sex, race, religion, culture, occupation, health insurance, marital status, dependents, contact person) : Presenting Symptom(s) : Symptom Analysis Precipitative & Palliative events: What makes the symptom(s) worse/what makes the symptom(s) better? Quality of the symptom(s) : What does it feel like? Region: Where are the symptom(s) located? Do the symptom(s) radiate? Do you have any other symptoms? Severity of the symptom(s) : How severe are the symptoms? What level is the pain on a scale of 1-10? Time: How long have the symptom(s) been present? How long do you the symptom(s) last? Past Health History (childhood diseases, surgery/injury, hospitalizations, allergies, medical problems, immunization, medications, foreign travel, military service, blood type/transfusions) : Family History (spouse, children, parents, siblings, aunt/uncles, grandparents) : II. Review of Systems: (Related to the Patient's Problems and Based on the Patient Interview) General: Skin, hair and nails: This study source was downloaded by from CourseH on :02:26 GMT -06:00 Head and neck: Ear, nose and throat: Eyes: Cardiovascular: Nervous: Immune: Pulmonary/Thorax: Musculoskeletal: Gastrointestinal: Genitourinary: Reproductive/Breast: Psychosocial (typical day, nutrition, activity and exercise, sleep and rest, selfcare responsibility, personal habits such as alcohol, smoking and drugs, role and relationship, stress and coping, pets and hobbies, environmental hazards) : III. Physical Assessment: Results of the Physical Examination of the Patient This study source was downloaded by from CourseH on :02:26 GMT -06:00 Vital Signs: (T, P, R, B/P) General Survey: Skin, hair and nails: Head and neck: Ear, nose and throat: Eyes: Cardiovascular: Pulmonary/Thorax: Gastrointestinal: Genitourinary: Nervous: Musculoskeletal: Immune: RTehipsrsotudduycstoivuerc/eBwreaas sdto:wnloaded by from CourseH on :02:26 GMT -06:00 IV. Summary Of The Health Assessment: Finding Pertinent to the Patient's Problem Pertinent Subjective Data: Pertinent Objective Data: V. Nursing Diagnoses: This study source was downloaded by from CourseH on :02:26 GMT -06:00