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| Present
complaints
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Please
mention all the main complaints
with their duration. In case certain
complaints, which are not permanent
but occur occasionally, you should
also mention details of those complaints.
Also specify if there is any relation
of your complaint with food, life
style, rest, exercise, season, medication,
work place, occupation etc. :
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History
of past illness
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the details of details previous illnesses
you have suffered in the past (e.g.
viral infections, injuries, systemic
diseases etc.) along with the age
of onset, duration and outcome. :
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Family
history:
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your near relatives had such complaint
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Any
known Allergy
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| Allergy
to particular food, medicines, dust,
climate or others :
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| State
of bowel movement, digestion, appetite
and sleep |
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Menstrual
History
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furnish following information. Age
of menarche. Whether the cycle is
regular or irregular and its duration?
Is the menstrual flow normal, scanty
or excess? Are you taking any contraceptive
pills? Age of menopause? Whether menstruation
is associated with any discomforts
like pain, vomiting, giddiness etc?
Any abnormal discharge? |
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Treatment taken
so far Mention the details of treatments
you underwent or you are undergoing
now. You should describe the order
of use of the medicines and the response
to the treatment |
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| Reports
of any clinical investigations
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| Our
Doctor will study your reports and
respond shortly |
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