Hi, I’m ________________. I’m a Nurse Practitioner student at Walden University and I’ll be completing your appointment today. I’d like to begin by asking you a few questions: *Before we get started, do you have any hearing or vision impairments that may hinder this interview?* ***Also, if you feel uncomfortable answering any of the questions asked, please let me know** ID and Personal Hx Can you please tell me your name and date of birth? And how would you like me to address you? Great, ____________, and please call me ________. What ethnicity to you identify as? What is your marital status? Chief Complaint So tell me what brings you in today? Stomach Ache Hx of Present Illness (O) Was the pain in your stomach sudden or did it gradually get worse? Gradual (L) Can you show me where the pain is located? Stomach (points) (D) How long have you been experiencing this pain? Within the last month off and on (C) Can you describe the pain? Is it sharp, dull, aching? Aching pain (A)/ (R) Is there anything that makes the pain better or worse? The pain is worse when I eat later than normal (T) How long does the pain usually last? It usually goes away after I eat. Do you take any medications to ease the pain? Yes, Tylenol and Pepcid (S)On a scale of 0 to 10 (0 being no pain and 10 being the worse painyou ever felt). How would you describe the severity of your pain? About a 5Past Medical HxDes, next I’d like to discuss your health history:
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- Summer '15