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Fhpim history and physical

NAME: ____________________________AGE: _____ PHONE: __________________HEIGHT: _____ WEIGHT:_____ CHIEF COMPLAINT: _____________________________________________________________________________ ______________________________________________________________________________________________ SUBJECTIVE SIGNS AND SYMPTONS: ________________________________________________________________ ______________________________________________________________________________________________ PREVIOUS TREATMENT: __________________________________________________________________________ ______________________________________________________________________________________________ OTHER PODIATRIC PROBLEMS: _________________________________________________________________________________ BUNIONS CORNS CALLUSES INGROWN NAILS HEEL PAIN ARCH PAIN ANKLE PAIN METATARSALGIA HOME TREATMENT FOR THIS CONDITION: __________________________________________________________________________________ _____________________________________________________________________________________________________________________________ HAVE YOU PERSONALLY EVER BEEN TREATED FOR ANY OF THE FOLLOWING CONDITIONS? CHEST PAIN ASTHMA KIDNEY PROB ANEMIA LIVER DISEASE BLEEDING PROB FOOT ULCERS HEART PROB ARTHRITIS BLOOD CLOTS STROKE NEUROPATHY HIGH CHOLESTEROL GOUT SICKLE CELL DIABETES THYROID PROB CANCER STOMACH ULCERS HIGH BLOOD PRESSURE OTHER: _____________________________________________________________________________________________________________________  I AM NOT CURRENTLY BEING TREATED FOR ANY CONDITIONS.
HAS ANYONE IN YOUR IMMEDIATE FAMILY EVER BEEN TREATED FOR ANY OF THE FOLLOWING CONDITIONS?
CHEST PAIN ASTHMA KIDNEY PROB ANEMIA LIVER DISEASE BLEEDING PROB FOOT ULCERS HEART PROB ARTHRITIS BLOOD CLOTS STROKE NEUROPATHY HIGH CHOLESTEROL GOUT SICKLE CELL DIABETES THYROID PROB CANCER STOMACH ULCERS HIGH BLOOD PRESSURE OTHER: ____________________________________________________________________________________ ADOPTED NO ONE IN MY IMMEDIATE FAMILY HAS EVER BEEN TREATED FOR ANY OF THE ABOVE CONDITIONS.

PREVIOUS SURGERIES: __________________________________________________________________________________________

______________________________________________________________________________________________
ALCOHOL: _____ NONE SOCIAL MODERATE HEAVY TOBACCO: CIG/DAY ______ HOW LONG? ______ ARE YOU PREGNANT? ______
CURRENT MEDICATIONS: ______________________________________________________________________________________
________________________________________________________________________________________________________________
ALLERGIES: I HAVE NO ALLERGIES. I AM ALLERGIC TO THE FOLLOWING: TYLENOL TAPE ASA KEFLEX CODIENE LATEX IODINE PENICILLIN SULFA MORTIN DARVON NOVOCAINE DEMEROL SHELL FISH OTHER: _________________________________________________________________________

Source: http://footandheel.com/fh-site/assts9305-foot/home/forms/HISTORYPHYSICAL_041610.pdf

Obesgen

PGx Cardio Farmacogenética en Cardiología Las enfermedades cardiovasculares son la primera El análisis proporciona información relevante acerca de causa de muerte y hospitalización en la población los 52 fármacos más utilizados, a partir del estudio de 49 española, ocasionando el 40% de todas las defunciones. polimorfismos genéticos en 27 genes descritos en la bibliografía c

Untitled

¿Es usted víctima de violencia intrafamiliar? No hay razón para que usted deba soportar maltratos. (d) Relación informal de cuidado - existe entre dos personas si una de ellas es o fue dependiente Si una persona con quien usted mantiene una relación de la otra (un cuidador) que ayuda a la persona en una actividad del diario vivir (actividades de cuidado personal). Este cuidado person

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