History Taking in Neurological Cases

HISTORY TAKING FORM FOR NEUROLOGICAL ILLNESS

Patient's particulars:

Name:

Age:

Gender:

Address:

Contact number:

Job:

Status:

Illness history:

a. Main complaint:

b. Progression history of current illness (OLD CART):

Onset (since when the illness occur?):

Location (which part of body affected?):

Duration (how long the duration of attack in every session?):

Character (what is the description of pain or illness? sudden or become worsen by time? the symptom occur on-off or continuously?):

Aggravating/ Alleviating factors (any contributing factors that worsen or lessen the symptom?):

Radiation (the pain or illness radiated to another part of body?):

Timing (which time the symptoms frequently occur?):

c. Past illness history (related to current illness) or having similar symptom before? (if any, since when the first attack occur? taking any medication for the previous attack? taking the medicine regularly or not?):

d. Past history of trauma (accident, assaulted, and/or fall): 

e. Social history (history of smoking and/or sport):

f. Underlying disease (chronic disease):

g. Past family history of illness:



Source:
- Copied and edited from 1 manual book for 6th semester medical school student from my university during my era.