Expanded Problem History Case Study 3 Problem Detailed Comprehensive Focused Focused Chief Complaint Absent Required Required Required Required □ Present □ History of Present Illness Location □ Duration □ Context □ Quality 1-3 1-3 > 3 □ > 3 Elements Severity Elements Elements Elements □ Modifying Factors □ Timing □ Associated Signs & □ Symptoms Review of Systems (ROS) Constitutional □ Eyes □ ENT □ Respiratory □ Cardiovascular □ GI □ Minimum 10 GU None 1 system 2-9 systems □ systems Musculoskeletal □ Skin □ Neurological □ Endocrinology □ Hematology/Lymphatic □ Immunologic/Allergy □ Psych □ Past/Family/Social History Past Medical History At least one New Patient 3/3 □ None None Family History of the three Est. Patient 2/3 □ Social History □
History Case Study 3 Problem Focused Expanded Problem Focused Detailed Comprehensive Chief Complaint □ Absent □ Present Required Required Required Required History of Present Illness □ Location □ Duration □ Context □ Quality □ Severity □ Modifying Factors □ Timing □ Associated Signs & Symptoms 1-3 Elements 1-3 Elements > 3 Elements > 3 Elements Review of Systems (ROS) □ Constitutional □ Eyes □ ENT □ Respiratory □ Cardiovascular □ GI □ GU □ Musculoskeletal □ Skin □ Neurological □ Endocrinology □ Hematology/Lymphatic □ Immunologic/Allergy □ Psych None 1 system 2-9 systems Minimum 10 systems Past/Family/Social History □ Past Medical History □ Family History □ Social History None None At least one of the three New Patient 3/3 Est. Patient 2/3