Gastrointestinal Bleeding History -
Gastrointestinal Bleeding
Onset prior to evaluation
Onset while:

A amount of blood was passed via
Now the bleeding has stopped by the time of this evaluation.

The blood contents is the color .

<-- black or maroon stools
<-- bright red rectal bleeding
<-- abdominal pain localized to
<-- rectal pain
<-- constipation
<-- diarrhea
<-- hematemesis
<-- nausea/vomiting

<-- lightheadedness on standing or near-syncope/syncope
<-- weakness
<-- fever

<-- history of peptic ulcer
<-- history of diverticulitis
<-- history of Cirrhosis or other portal hypertension
<-- history of other bleeding sites (genitourinary, epistaxis, hemoptysis)
<-- history of known bleeding disorder

<-- Warfarin use
<-- Aspirin or NSAID use
<-- Excessive alcohol use

<-- history of serious CNS risks (e.g. active cancer, immunosuppression, HIV)
<-- History of rectal trauma (e.g. intercourse)

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