Complete Review Of Systems

Front 1

General(complete review of systems):

Back 1

“Do you have fever or chills?”
“Have you lost any weight?”
“Have you had any changes in your appetite?”
“Have you noticed any weakness in any part of the body?”
“Do you feel tired?”
“Have you had any sweats that drench your clothes or the sheets at night?”
“Have you been exposed to any radiation in the past?”

Front 2

Skin(complete review of systems):

Back 2

“Have you had any rashes or changes in skin color?”
“Have you had increased itching in any part of the body?”
“Have you had bumps develop on your skin, known as hives?”
“Have you developed bruises more easily than usual?”
“Have you had eczema before?”
“Is your skin drier than usual?”
“Have you had any changes in your hair?”
“Have you had any changes in your nails?”

Front 3

HEENT:
Head(complete review of systems):

Back 3

“Do you have headaches?”
“Do you have any dizziness?”
“Have you passed out?”
“Have you had any injury to your head, such as falls?”

Front 4

HEENT:
Eyes(complete review of systems):

Back 4

“Do you have any vision problems, such as double vision or blurry vision?”
“Have you been having more watery eyes?”
“Do you have pain in your eyes?”
“Are your eyes more sensitive to light recently?”
“Have you had any redness or discharge from your eyes?”
“Have you had any injury to your eyes?”

Front 5

HEENT:
Ears(complete review of systems):

Back 5

“Have you had any hearing loss or difficulties?”
“Do you have pain either inside or on the outside of the ear?”
“Have you had any discharge from your ears?”
“Do you have ringing in your ears or hear an unusual sound?”

Front 6

HEENT:
Nose(complete review of systems):

Back 6

“Do you have any nasal discharge?”
“Are you having nosebleeds?”
“Do you have any nasal blockage?”
“Have you had any injury to your nose?”
“Do you have any history of sinus infections?”

Front 7

HEENT:
Throat and mouth(complete review of systems):

Back 7

“Have you had bleeding from your gums?”
“Have you had any sore throat?”
“Do you have any changes in your voice?”
“Have you had drainage in your throat?”
“Do you have any difficulties swallowing?”

Front 8

Neck(complete review of systems):

Back 8

“Have you noticed any lumps in your neck?”
“Do you have any neck pain when you move it?”
“Does your neck hurt when it is touched?”

Front 9

Cardiac(complete review of systems):

Back 9

“Do you have any chest pain?”
“Do you feel that your heart races or goes fast?”
“Do you get short of breath when you walk? If so, how far can you walk before
becoming short of breath?”
“Do you get short of breath when you lay down to sleep?”
“Do you wake up in the night with shortness of breath that improves after you sit up
for 10-15
minutes?”
“Have you had rheumatic fever in the past?”

Front 10

Pulmonary/Chest(complete review of systems):

Back 10

“Have you had any cough? If so, are you coughing anything up?”
“What color is the sputum?”
“Are you coughing up any blood? If so, how much blood are you coughing up?”
“How much are you coughing up?”
“Does it hurt in your chest when you take a deep breath?”
“Have you had any shortness of breath?”
“Have you been tested for TB before?”
“Have you had the BCG vaccine for TB?”

Front 11

Vascular(complete review of systems):

Back 11

“Do you have pain in your legs, calves, or thighs while walking?”
“Have you had swelling in your legs?”
“Do you have varicose veins?”
“Have you had any blood clots in your legs before?”
“Do your arms or legs feel cooler than the rest of the body?”
“Have you had hair loss on your legs?”
“Have you had color changes in your arms or legs?”
“Have you had skin ulcers in your legs or arms before?”

Front 12

Breasts(complete review of systems):

Back 12

“Have you noticed any lumps in either breast?”
“Have you had any discharge from the nipples?”
“Do you have pain in either breast?”
“Have you noticed any skin color changes?”

Front 13

Gastrointestinal(complete review of systems):

Back 13

“Have you been more thirsty than usual?”
“Have you had any nausea or vomiting? If so, are you throwing up blood?”
“Have you had any constipation or diarrhea?”
“Have you had pain after eating meals or at night?”
“Have you had any belly pain?”
“Do you have any blood in your stool?”
“Has your stool become thinner recently?”
“Does your stool appear black?”
“Has your belly become bigger?”
“Have you had any pain with bowel movements?”
“Have you had yellow eyes or skin?”

Front 14

Psychiatric(complete review of systems):

Back 14

“Have you had difficulty falling asleep or staying asleep at night?”
“Have you noticed a change in your mood recently? If so, do you think that it is more
depressed than usual?”
“Have you seen or heard things that others do not see or hear?”

Front 15

Endocrine(complete review of systems):

Back 15

“Do you feel warm if everyone else in the room appears comfortable?”
“Do you feel cold if everyone else in the room appears comfortable?”

Front 16

Immunology(complete review of systems):

Back 16

“Do you have any seasonal allergy symptoms to the environment?”
“Have you had any recent infections?”
Hematological/Lymphatic:
“Have you noticed any lumps or bumps anywhere on the body?”
“Have you been bleeding more easily than usual?”

Front 17

Urinary(complete review of systems):

Back 17

“Have you had to go to the bathroom more often?”
“Do you feel like you have to go more often but do not urinate very much?”
“Does it burn when you urinate?”
“Do you have blood in the urine?”
“Do you have difficulty starting your urination?”
“Have you had difficulty controlling your urine such that you leak during the day or
night?”
“Do you have any pain in the side of your lower back?”
“Do you wake up from sleep to urinate at night? If so, how many times?”
“Are you unable to empty your urine?”
“Have you had kidney stones in the past?”

Front 18

Male genitalia(complete review of systems):

Back 18

“Have you developed any sores on your penis? If so, are they painful?”
“Have you had any discharge from your penis?”
“Have you had any pain in the penis, scrotum, or testicles?”
“Have you had any prostate problems in the past?”
“Have you been treated for any sexually transmitted diseases in the past? If so, which
ones and what treatment did you receive?”
“Do you have any difficulty with sexual relations?”
“Have you had a hernia before?”

Front 19

Female Genitalia(complete review of systems):

Back 19

“Have you had any sores or growths on the vaginal area?”
“Have you had any itching in the vaginal area?”
“Have you had any vaginal discharge?”
“Do you have any problems with sexual relations, such as pain?”
“What age did you start having periods?”
“How often are your periods?”
“How many days do your periods last?”
“How many pads or tampons do you use each day and on the heaviest day of your periods?”
“When was your last period?”
“Have you had any bleeding between periods?”
“Have you had any irregular periods?”
“Have you had excessive bleeding than usual during your periods?”
“Do you have excessive pelvic pain during your periods or before your periods?”

Front 20

Symptoms of menopause(complete review of systems)

Back 20

“Have you stopped having periods? If so, when?”
“Do you have episodes when you feel hot but everyone else feels comfortable
in the room?”
“Have you or others around you noticed any changes in your mood?”
“Have you had any bleeding since your periods stopped?”
“Have you had pain with intercourse?”
“Do you have any vaginal dryness?”

Front 21

Musculoskeletal(complete review of systems):

Back 21

“Do you have any weakness in your legs or arms?”
“Have you had any stiffness in your muscles?”
“Do you have any stiffness when moving any of your joints?”
“Do you have any pain in your joints?”
“Have you had any swelling in your joints?”
“Have you been diagnosed with arthritis?”
“Do you have any back pain? If so, where?”
“Do you have any muscle cramps?”

Front 22

Neurologic(complete review of systems):

Back 22

“Do you have numbness or tingling in any part of the body?”
“Have you passed out at all?”
“Have you noticed a tremor in any part of your body?”
“Have you had any problems with your memory?”
“Do you have any difficulty with your speech?”
“Have you had problems with walking?”
“Has anyone noted any changes in your thinking or behavior?”
“Do you feel that you don’t know where you are or become lost?”