Review of Systems

Constitutional: fever, chills, weight loss, weight gain, weakness

EENT: vision loss, vision changes, pain, double vision, glasses, contacts, cataracts, glaucoma, last 

            eye exam, hearing changes, ringing in ears, dizziness, ear discharge, ear pain, nasal

            congestion, running nose, sinus pain, sore throat, hoarseness, voice changes, mouth

            sores, dentures, last dental visit                         

CV: chest pain, chest tightness, palpitations, shortness of breath, racing heart, high blood

        Pressure, high cholesterol, heart attack, leg cramps

RESP: cough, sputum, coughing up blood, wheezing, shortness of breath, painful breathing

GI: difficulty swallowing, Heartburn, Indigestion, change ball habits, blood in stool, appetite      

      changes, nausea, Vomiting, Diarrhea, Constipation, last colonoscopy

GU: urinary frequency, urgency, Incontinence, burning or pain, blood and urine, vaginal or  penile


MS: Stiffness, back pain, redness or swelling of joints, Injuries

NEURO: headache, Head injury, dizziness, seizures, tremors, tingling, numbness, memory loss,

               balance problems, falls

INT:  rashes, lumps, itching, hair or nail changes, changing moles, new moles

PSYC: depression, anxiety, stress, nervousness, excessive worry, diminished interest and

             activities, feelings of hopelessness, Suicidal thoughts

ENDOCRINE: Heat or cold intolerance, sweating, unexplained weight loss, excessive hunger or

                       thirst, frequent urination

HEMATOLOGY:  Easy bruising, excessive bruising, easy bleeding, anemia, blood disease,

                            cancer, blood transfusions