(No patient names or initials allowed).
Submit using Word, with a .doc or .dox suffix; do not use .odt because the forms cannot be graded in that format—this goes for the assignments in all the upcoming weeks for this class.
|2. Present health concerns|
|3. Current medications (prescribed and over-the-counter)|
|9. List family medical concerns for 3 generations|
|Pain||(Everyone has had pain at some time or other-if your patient is healthy and currently pain-free, you may need to use a past instance of pain.)|
|10. Pain (using COLDSPA)|
Character: how does it feel—what sort of pain is it?
|14. Severity (scale of 1 – 10):|
|15. Pattern—what makes it better or worse:|
|16. Associated factors—does it cause you to have other symptoms too?|
|18. How does pain impact the other areas of life?||2. What are your concerns about the pain’s effect on|
a. general activity?
d. physical ability?
f. relations with other people?
i. enjoyment of life?
|Lifestyle and Health Practices|
|What types of recreation or physical exercise?|
|Duration of exercise periods, how many times per week?|
|Stress: Rate overall life stress on a scale of 1 – 10 (1 being least, 10 most). What are the greatest sources of stress?|
|Methods of coping with stress?|
|Use of tobacco, alcohol, recreational drugs|
|Sleep—typical hours per night|