Health History and Examination

Health Assessment of the Head, Neck, Eyes, Ears, Nose, Mouth, Throat, Neurological System, and the 12 Cranial Nerves Skin, Hair, Nails, Breasts, Peripheral Vascular System, Lymphatics, Thorax, Heart, Lungs, Musculoskeletal, Gastrointestinal, and Genitourinary Systems

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Student Name: | Date: |

Client/Patient Initials: | Sex: | Age: | Occupation of Client/Patient: | Health History/Review of Systems(Complete and systematic review of systems) | Neurological System (headaches, head injuries, dizziness, convulsions, tremors, weakness, numbness, tingling, difficulty speaking, difficulty swallowing, etc., medications): Patient is oriented x3. No major memory deificit was noted or reported. Patient if forgetful at times due to the aging. Has BLE muscle weakness and pain due to the disease process. No history of tremors or seizures was reported. No numbness or tingling was reported. Patient speech is clear; no difficulty in swallowing was reported or observed. Patient takes Aspirin 81mg PO daily prophylactically. | Head and Neck (pain, headaches, head/neck injury, neck pain, lumps/swelling, surgeries on head/neck, medications): Per patient “I get occasional headaches but is relived with the pain medication. I have LBP less often then daily but is relieved with the medications”. On assessment no swelling or lumps were noted. No history or surgeries on the back and neck was reported. Patient takes Tylenol 500 mg 1-2 PO PRN. | Eyes (eye pain, blurred vision, history of crossed eyes, redness/swelling in eyes, watering, tearing, injury/surgery to eye, glaucoma testing, vision test, glasses or contacts, medications): Patient reported cataract surgery 10-12