Maternal grandfather Died of heart attack age 54 paternal grandmother Died of

-Maternal grandfather: Died of heart attack , age 54 -paternal grandmother: Died of pneumonia, age 78 -Paternal grandfather : Died of old age , age 85 -Healthy, age 26 -Daughter: Asthma, age 19 Review of Systems(ROS): Address all body systems that may help rule in or out a differential diagnosis Check the box next to each positive symptom and provide additional details.ConstitutionalSkinHEENT☐Fatigue: Denies ☐Weakness: Denies ☐Fever/Chills: Denies ☐Weight Gain: Report 20lb weight gain over the years . ☐Weight Loss: Denies ☐Trouble Sleeping:Denies ☐Night Sweats: Denies ☐Other: ☐Itching: Denies ☐Rashes: Denies ☐Nail Changes: Denies ☐Skin Color Changes:Denies☐Diplopia: Denies ☐Eye Pain:Denies. ☐Eye redness:Denies ☐Vision changes:Denies ☐Photophobia: Denies ☐Eye discharge:Denies ☐Earache: Denies ☐Tinnitus: Denies ☐Epistaxis: Denies. ☐Vertigo: Denies. ☐Hearing Changes:Denies☐Hoarseness: Denies ☐Oral Ulcers: Denies ☐Sore Throat: Denies ☐Congestion:Denies ☐Rhinorrhea: Denies RespiratoryNeuroCardiovascular

☐Cough: Denies ☐Hemoptysis: Denies ☐Dyspnea : Denies ☐Wheezing: Denies ☐Pain on Inspiration: Denies ☐Sputum Production: Denies Other: Presence of fine crackles ☐Syncope or Lightheadedness:Denies ☐Headache: Denies ☐Numbness:Denies ☐Tingling: Denies ☐Sensation Changes: Denies ☐Speech Deficits: Denies ☐Chest pain: Denies chest pain at this time.Last episode of chest pain occurred last week end (last Friday evening). Report severity of pain at a 5 0n 10. characteristics of pain as tight and uncomfortable ☐SOB: Denies ☐Exercise Intolerance: Reports pain worsens with physical activity such as yard work or climbing the stairs ☐Orthopnea:Denies ☐Edema: Denies ☐Murmurs:Denies ☐Palpitations:Denies ☐Faintness:Denies ☐OC Changes :Denies ☐Claudications: Denies ☐PND :Denies. ☐Other:Denies pain radiationMSK GIGUPSYCH☐Pain: Denies any current pain at this time ☐Stiffness: Denies ☐Crepitus: Denies ☐Swelling:Denies ☐Limited ROM:Denies ☐Redness:Denies ☐Misalignment:Denies ☐Other:Denies ☐Nausea/Vomiting:Denies ☐Dysphasia:Denies ☐Diarrhea:Denies ☐Appetite Change;Denies ☐Heartburn:Denies ☐Blood in Stool:Denies ☐Abdominal Pain:Denies ☐Excessive Flatus:Denies ☐Food Intolerance:Denies ☐Rectal Bleeding:Denies☐Urgency:Denies ☐Dysuria: Denies ☐Burning:Denies ☐Hematuria: Denies ☐Polyuria: Denies ☐Nocturia: Denies ☐Incontinence:Denies ☐Stress:Reports very low stress. ☐Anxiety:Denies ☐Depression:Denies ☐Suicidal/Homicidal Ideation:Denies ☐Memory Deficits:Denies ☐Mood Changes:Denies ☐Trouble Concentrating:Denies GYN☐Rash:Denies ☐Discharge:Denies ☐Itching:Denies☐Irregular Menses:NA ☐Dysmenorrhea: NA ☐Foul Odor:NA☐Amenorrhea: NA ☐LMP:NA ☐Contraception: DeniesO:Objective Information gathered during the physical examination by inspection, palpation, auscultation, and palpation. If unable to assess a body system, write “Unable to assess”. Document pertinent positive and negative assessment findings.

and SBody SystemPositive Findings Negative FindingsGeneral Choose an item.