ESTHER_PARK_SHADOW_HEALTH_INTERVIEW
Do you have any abdominal pain?
I’m sorry you’re having these symptoms; it sounds like you’re under great
discomfort. It’s good that you came in today so we can discuss how to
alleviate your discomfort and improve your gastrointestinal health ."
EMPATHIZE
Are you able to have a bowel movement?
Can you tell me who you are?
Do you know where you are right now?
Do you know why you are here today?
What is the date and year?
How long have you had stomach pain Has the
stomach pain changed?
Where is your discomfort located?
Is the pain in a specific spot?
Do yo have pain on your sides?
How would you rate your pain on a scale of one to ten?
How would you rate your pain at its lowest/ worst? Can you
describe the pain Is yor pain constatnt?
Dose your pain fluctuate?
What relieves your pain beside medication?
Have you taken medication for the stomach pain?
Have you taken laxatives?
Dose eating aggravate the pain?
Does physical activity aggravate the pain?
How has your illness affected your daily life?
Have you had low energy?
Are you constipated right now?
For low ong have you been constipated?
Have you had diarrhea recently?
How long ago did you get diarrhea?
Did the diarrhea happen suddenly?
How long did you diarrhea last?
Has there been mucus in your stool?
Has there been blood in your stool?
Have you have any changes in the frequency of your urination?
Has your urine been darker recently?
,Have you had blood in your urine?
Have you been thristier latetly?
Have you had changes in your fluid intake?
How many glasses of water do you drink daily?
Do you drink caffeinated beverages?
Are you typically constipated?
How many bowel movement do ou typically have per week?
Are your stools typically brown/formed/soft?
Do you have a allergy?(latex)/ are you allergic to any medications?/ do you have any food allergies?
Do you have a primary care doctor?
When was your last pap smear?
Do you feel you are healthy?
Have you had a colonoscopy?
Have you every been tested for STIs?
Have you had STI symptoms?
Are you sexually active?
Do you have HTN? Do you take HTN medication?
What medication do you take for your HTN?
What does is your HTN medication? When do you take your HTN medication?
Do you take any over the counter medication?
Did you have any complications during pregnancy?
At what age did you have a c-sections?
Have you had your cholecystectomy? = have you had your gallbladder removed?
At what age did you have your gallbladder removed?
Did you have any complications after your surgery?
Do you have difficulty “getting on and off the toilet?/ dressing yourself?/feeding yourself?/
walking?/ bathing yourself?/ getting in and out of chairs?”
What was your last meal?
How many meals do you typically eat per day?
What doyou typically eat for a snack?
What do you usually eat for breakfast/lunch/dinner?
Do you take fiber supplement?
Do you think you get enough fiber?
What source of fiber do you eat?
Do you eat fruit?
How much do you drink water per a day?
, "It’s a really healthy practice to be drinking water every day, and it’s great that you are! You have
room to drink even a few more glasses per day, or as much as is comfortable. This would help
prevent dehydration and increase your overall health, especially in your gastrointestinal system."
"Thanks for telling me about your diet. The USDA recommends that adults eat around 28
grams of fiber per day, which is several servings of fruits, vegetables, and whole grains.
Enough fiber can help regulate your digestive system and prevent gastrointestinal upsets, so
let’s talk about ways you might increase your fiber intake." Do you stay active?
What is your typical activity level?
"I’m sorry you’ve been more tired and haven’t been able to live your daily life with your normal vigor. It’s
always unpleasant when an illness makes you feel unlike yourself. Rest assured that we will work to improv
your energy
levels and get you able to participate in your regular activities." Do you use drugs?
Smoke? Drink?
How many nights a week do you drink alcohol?
How many alcoholic drinks do you have in a mounth When you have
alcohol, what do you typically drink?
Do you live with anyone?
Who can you go to for spport?
Have you traveled anywhere recently?
How you experienced any physical abuse?
Have you experienced any sexual abuse?
Have you experienced any emotional / verbal/ fianacial/ abuse?
Have you had any recent weight changes?
Have you had a fever recently?
Have you had chills?
Do you have night sweats?
Have you had any swelling?
Do you have fatigue?
Have you had difficulty sleeping?
Do you have a history of heartburn?
Have you ever had appendicitis?
Do you have a history of stomach cancer?
Do you have a history of liver disease?
Do you have palpitations?
Do you have chest pain?
Does your heart race?
Do you have a sore throat?
Have you been coughing?
, Do you have difficulty swallowing?
Have you had difficulty breathing?
Do you feel bloated?
Do you have more gas than usual?
How is your appetite?
Do you have nausea?
How you been vomiting?
Do you have food poisoning?
Do you have a history of bladder disease?
Do you have any pain when you urinate?
Do you have burning with urination?
Do you have problems hold your urine?
Have you had past UTI?
Do yo hold your urin in unnecessarily?
Do you have any gynecological problems?
Do yo have vaginal bleeding?
Do you have vaginal discharge?
When did you start menopause?
Do you have history of kidney disease?
Inspected head and face
Skull Symmetry (No point)
• Symmetric
Facial Feature Symmetry (No point)
• Symmetric
Appearance (No point)
• Flushed appearance
Inspected nasal mucosa
Appearance (No point)
• Moist and pink
Inspected mouth Oral Mucosa
(No point)
• Moist and pink
Inspected abdomen Symmetry (No
point)
Do you have any abdominal pain?
I’m sorry you’re having these symptoms; it sounds like you’re under great
discomfort. It’s good that you came in today so we can discuss how to
alleviate your discomfort and improve your gastrointestinal health ."
EMPATHIZE
Are you able to have a bowel movement?
Can you tell me who you are?
Do you know where you are right now?
Do you know why you are here today?
What is the date and year?
How long have you had stomach pain Has the
stomach pain changed?
Where is your discomfort located?
Is the pain in a specific spot?
Do yo have pain on your sides?
How would you rate your pain on a scale of one to ten?
How would you rate your pain at its lowest/ worst? Can you
describe the pain Is yor pain constatnt?
Dose your pain fluctuate?
What relieves your pain beside medication?
Have you taken medication for the stomach pain?
Have you taken laxatives?
Dose eating aggravate the pain?
Does physical activity aggravate the pain?
How has your illness affected your daily life?
Have you had low energy?
Are you constipated right now?
For low ong have you been constipated?
Have you had diarrhea recently?
How long ago did you get diarrhea?
Did the diarrhea happen suddenly?
How long did you diarrhea last?
Has there been mucus in your stool?
Has there been blood in your stool?
Have you have any changes in the frequency of your urination?
Has your urine been darker recently?
,Have you had blood in your urine?
Have you been thristier latetly?
Have you had changes in your fluid intake?
How many glasses of water do you drink daily?
Do you drink caffeinated beverages?
Are you typically constipated?
How many bowel movement do ou typically have per week?
Are your stools typically brown/formed/soft?
Do you have a allergy?(latex)/ are you allergic to any medications?/ do you have any food allergies?
Do you have a primary care doctor?
When was your last pap smear?
Do you feel you are healthy?
Have you had a colonoscopy?
Have you every been tested for STIs?
Have you had STI symptoms?
Are you sexually active?
Do you have HTN? Do you take HTN medication?
What medication do you take for your HTN?
What does is your HTN medication? When do you take your HTN medication?
Do you take any over the counter medication?
Did you have any complications during pregnancy?
At what age did you have a c-sections?
Have you had your cholecystectomy? = have you had your gallbladder removed?
At what age did you have your gallbladder removed?
Did you have any complications after your surgery?
Do you have difficulty “getting on and off the toilet?/ dressing yourself?/feeding yourself?/
walking?/ bathing yourself?/ getting in and out of chairs?”
What was your last meal?
How many meals do you typically eat per day?
What doyou typically eat for a snack?
What do you usually eat for breakfast/lunch/dinner?
Do you take fiber supplement?
Do you think you get enough fiber?
What source of fiber do you eat?
Do you eat fruit?
How much do you drink water per a day?
, "It’s a really healthy practice to be drinking water every day, and it’s great that you are! You have
room to drink even a few more glasses per day, or as much as is comfortable. This would help
prevent dehydration and increase your overall health, especially in your gastrointestinal system."
"Thanks for telling me about your diet. The USDA recommends that adults eat around 28
grams of fiber per day, which is several servings of fruits, vegetables, and whole grains.
Enough fiber can help regulate your digestive system and prevent gastrointestinal upsets, so
let’s talk about ways you might increase your fiber intake." Do you stay active?
What is your typical activity level?
"I’m sorry you’ve been more tired and haven’t been able to live your daily life with your normal vigor. It’s
always unpleasant when an illness makes you feel unlike yourself. Rest assured that we will work to improv
your energy
levels and get you able to participate in your regular activities." Do you use drugs?
Smoke? Drink?
How many nights a week do you drink alcohol?
How many alcoholic drinks do you have in a mounth When you have
alcohol, what do you typically drink?
Do you live with anyone?
Who can you go to for spport?
Have you traveled anywhere recently?
How you experienced any physical abuse?
Have you experienced any sexual abuse?
Have you experienced any emotional / verbal/ fianacial/ abuse?
Have you had any recent weight changes?
Have you had a fever recently?
Have you had chills?
Do you have night sweats?
Have you had any swelling?
Do you have fatigue?
Have you had difficulty sleeping?
Do you have a history of heartburn?
Have you ever had appendicitis?
Do you have a history of stomach cancer?
Do you have a history of liver disease?
Do you have palpitations?
Do you have chest pain?
Does your heart race?
Do you have a sore throat?
Have you been coughing?
, Do you have difficulty swallowing?
Have you had difficulty breathing?
Do you feel bloated?
Do you have more gas than usual?
How is your appetite?
Do you have nausea?
How you been vomiting?
Do you have food poisoning?
Do you have a history of bladder disease?
Do you have any pain when you urinate?
Do you have burning with urination?
Do you have problems hold your urine?
Have you had past UTI?
Do yo hold your urin in unnecessarily?
Do you have any gynecological problems?
Do yo have vaginal bleeding?
Do you have vaginal discharge?
When did you start menopause?
Do you have history of kidney disease?
Inspected head and face
Skull Symmetry (No point)
• Symmetric
Facial Feature Symmetry (No point)
• Symmetric
Appearance (No point)
• Flushed appearance
Inspected nasal mucosa
Appearance (No point)
• Moist and pink
Inspected mouth Oral Mucosa
(No point)
• Moist and pink
Inspected abdomen Symmetry (No
point)
