A pt profile template

Pearl: Whatever you don't ask, you don't know. Do NOT ASSUME!!!

I - Basics: 

age, gender, ethnicity

marital status, religion

II - Cc:

III - PMH:

1 - Major illnesses:

2 - Recent minor illnesses

3 - Hospitalizations

4 - Surgeries

5 - Allergies

6 - Meds

7 - Screening history

8 - Social history

9 - Family history

10 - ROS: 

IV - Physical examinations:

V - Assessment: