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Background and managementClinical symptomsFunctional status
When was the condition diagnosed?Which specialist do you see? When did you last see them?What management, medical or surgical, have you had so far?What has been the tempo of progression of the disease?
What are you current living circumstances?Does anybody else live with you?How do you manage with basic ADLs (bathing, toileting, dressing, eating)?How do you manage with instrumental ADLs (meal preparation, shopping, management of finances, caring for others)?
Dyspnoea (exertional, orthopnoea, PND)Chest painPalpitationsSyncopePeripheral oedemaIntermittent claudicationFatigue
DyspnoeaCoughWheezeSputum productionHaemoptysisChest painFeverHoarse voiceNight sweats
History
General Structure
Background and Management
Functional Status
Cardinal Symptoms
Cardiovascular
Respiratory
Hepatic
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