Review of Systems (ROS)

Constitutional = General + VITALS: BP: Pt. perception of health Change in sleep Night sweats Fever or Chills HEENT: Head: Frequent or unusual headaches Location Dizziness Syncope Severe head injuries Loss of consciousness Momentary or prolonged Eyes: Use of glasses/contacts Visual acuity Change in appearance/ specks /blind spots? Change in vision Blurring Double vision Light sensitivity / flashing lights? Pain Tearing? Use of eye drops or other medication History of trauma Glaucoma or familial eye disease cataracts Ears: Hearing loss Frequent infections / Ear ache? Pain Discharge Tinnitus Vertigo Nose: Altered smell Frequent colds / stuffiness Obstruction Nosebleeds Postnasal drip / discharge Sinus pain Throat and mouth: Hoarseness Change in voice Frequent sore throat Bleeding or swelling of gums Tooth abscess or loss / dentures Non-healing sores / ulcers Thrush Altered taste Snoring and or snoring partner MAM: 6-28-05 JDE: Rev. 07-14-2012 / , HR b/m, Resp: ,Temp: F, Ht: Strength or Weakness Energy level? Easily fatigued? Exercise tolerance Ability conduct usual activities Thirst & Appetite Wt: lbs/ k, BMI: Weight loss or gain Average lbs. Preferred Change lbs. lbs.

Neck: Neck pain FROM? Or stiffness Lumps / thyroid enlargement LAD JVD Respiratory & Chest: Respiratory pain Dyspnea SOB Wheezing or stridor Cough what time of day Sputum Color and quantity Hemoptysis Fever or night sweats Exposure to tuberculosis Clubbing of fingers Cyanosis Last CXR Cardiovascular Heart: Precordial pain or substernal distress Precipitating causes Timing and duration Relieving factors Tightness Palpitations Syncope Dyspnea on exertion (DOE) Paroxysmal nocturnal dyspnea (PND) Orthopnea w/ Number of pillows Edema Claudicating Cyanosis HTN Hx of murmurs Previous myocardial infarction Exercise tolerance Past cardiac tests Blood Vessels: Claudication / calf pain w/ walking Leg cramping Varicose veins Thrombophlebitis Thrombosis Page 1

Review of Systems (ROS)

Chest (Breasts): Pain Tenderness Lumps Nipple discharge Galactorrhea Mammograms (screening or diagnostic) Frequency of BSE GI - Gastrointestinal: Swallowing difficulties (dysphagia) Change in Appetite Digestion / indigestion Intolerance of any foods Food idiosyncrasy / pica Abdominal pain Heartburn Nausea Vomiting / Hematemesis Belching Bowel regularity / change? Constipation Diarrhea Change in stool Color Clay, Tarry contents Fresh blood Mucus / greasy Flatulence Hemorrhoids Jaundice Dark urine History of ulcer Hepatitis Gallstones Polyps Tumor Past x-ray or screening tests Where, When, Findings? EndocrineGeneral: Thyroid enlargement or tenderness Heat or cold intolerance Sweating Diabetes Unexplained weight change Polydipsia Polyuria Changes in facial or body hair Increased hat and glove size Skin striae Asthenia Hormone therapy Secondary sexual development MAM: 6-28-05 JDE: Rev. 07-14-2012 GU: Dysuria Flank or suprapubic pain Urgency Frequency Nocturia Hematuria Polyuria Hesitancy / Dribbling / Loss in force of stream Passage of stone Edema of face Incontinence stress or urge Hernias Sexually transmitted disease (STD) Males: Puberty onset Erections Emissions Testicular pain Libido Infertility Frequency of testicular self-examination Females: Menarche Menses: Regularity Duration Flow LMP Dysmenorrhea Metrorrhagia Inter-menstrual discharge Bleeding Itching Date of last Pap smear Age at 1st intercourse Number of partners Sexual difficulties / dyspareunia Infertility Gravidity and parity: G = # of pregnancies T = # of term babies, P = # of preterm babies A = # of abortions/miscarriages L = # of living children Delivery method Any pregnancy or postpartum complications Contraceptive method Menopausal symptoms Flushing, Sweats Vaginal dryness Age at menopause Libido Post-menopausal bleeding Page 2

Review of Systems (ROS)

Musculoskeletal: Pain Swelling Joint stiffness Joint or muscle Pain Limitation of motion Back pain Trauma Swelling of joints Redness or heat of joints Bony deformity Atrophy Cramps Skin/Breast Skin, hair, nails: Rash or eruption Itching Pigmentation or texture change Lumps Dryness Excessive sweating Changes in hair growth or loss Nail or hair changes Neurologic: Dizziness Syncope Seizures Weakness Paralysis Numbness Problems with sensation Motor disturbances Incoordination Tremors Ataxia Tingling / parathesias Difficulties with memory of speech Psychiatric: Predominant mood Emotional problems Anxiety Depression Mood changes Difficulty concentrating Memory loss Nervousness Stress Tension Suicidal thoughts Irritability Sleep disturbances Past psychiatric treatment Usual perceptions Hallucinations Hematologic: Anemia Easy bruising/bleeding Blood cell disorder Past transfusions Rh incompatibility Local or general LAD or tenderness Lymphatic: Enlargement Tenderness Suppuration Allergic/Immunologic: Rxn to drugs Food Insects Skin rashes Trouble breathing

MAM: 6-28-05 JDE: Rev. 07-14-2012

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