Past medical history

Past medical history

Cardiovascular history: [checkbox name="cardiac_hx" value="None|Chest pain/angina|Congestive Heart Failure|Hypertension|Hypotension|Hyperlipidemia|Coronary Artery Bypass Graft|Stent Placement|Pacer|Defibrillator|PPM-Defib|Deep Vein Thrombosis|Coronary Artery Disease|Transplant|Previous Myocardial Infarction|Cardiac Arrest|Valve Replacement|Atrial Fibrillation or other arrhythmia"]


Respiratory history:
asthma
Chronic Obstructive Pulmonary Disease
bronchitis
sleep apnea
Emphysema
Pleurisy
pneumonia (frequent or persistent)
tracheostomy

Communicable Disease:
Hep A
Hep B
Hep C
HIV/AIDS
Tuberculosis
Meningitis


Neurological History:
Chronic Pain
Head Injury / Concussion
Seizure Disorder
Chronic headache
Stroke
Loss of Consciousness
Numbness
Tremors
Weakness
Headaches / Migraines
Frequent / Recent Falls
Fainting / Dizziness


Medical Device History:
Bipap
CPAP
Oxygen
Pacemaker
Insulin Pump
Cane
Walker
Dentures
Glasses

Musculoskeletal history:
arthritis
amputation
back/neck problems
congenital abnormalities
fibromyalgia
osteoporosis
metal implants

Endocrine/Metabolic:
Acromegaly
Addison's Disease
Adrenal Disorders
Cushing's Syndrome
De Quatrain's Thyroiditis
Diabetes
Gestational Diabetes
Goiters
Graves' Disease
Growth Disorders
Growth Hormone Deficiency
Hashimoto's Thyroiditis
Hyperglycemia
Hyperparathyroidism
Hyperthyroidism
Hypoglycemia
Hypoparathyroidism
Hypothyroidism
Low Testosterone
Menopause
Metabolic Syndrome
Obesity
Osteoporosis
Parathyroid Diseases
Pheochromocytoma
Pituitary Disorders
Polycystic Ovary Syndrome
Prediabetes
Silent Thyroiditis
Thyroid Diseases
Turner Syndrome
Type 1 Diabetes
Type 2 Diabetes

Integumentary:
Ulcers
eczema
psoriasis
skin breakdown
Cancer
Lupus
Fibromyalgia
Multiple Sclerosis
Arthritis
Shingles


EENT history:
ear problems
eye problems
nasal/sinus problems

Sexual/Reproductive history:
Abnormal bleeding/discharge
birth control
menopause
sexually active
sexually transmitted disease
recent pregnancy
currently pregnant

GI:
Appendicitis
Bowel obstruction
Esophagitis
Food poisoning
Hemorrhoids
Kidney disease
Kidney stones
Peptic ulcer
Peritonitis
Ulcer
Urinary tract infections (frequent or persistent)
Pancreatitis
Crohn's
Gastric Esophageal Reflux Disease
colostomy
Parkinson's
Gallstones
gastric bypass
rectal bleeding
Colitis
Diverticulitis
Liver failure
Past medical history

Cardiovascular history:


Respiratory history:
asthma
Chronic Obstructive Pulmonary Disease
bronchitis
sleep apnea
Emphysema
Pleurisy
pneumonia (frequent or persistent)
tracheostomy

Communicable Disease:
Hep A
Hep B
Hep C
HIV/AIDS
Tuberculosis
Meningitis


Neurological History:
Chronic Pain
Head Injury / Concussion
Seizure Disorder
Chronic headache
Stroke
Loss of Consciousness
Numbness
Tremors
Weakness
Headaches / Migraines
Frequent / Recent Falls
Fainting / Dizziness


Medical Device History:
Bipap
CPAP
Oxygen
Pacemaker
Insulin Pump
Cane
Walker
Dentures
Glasses

Musculoskeletal history:
arthritis
amputation
back/neck problems
congenital abnormalities
fibromyalgia
osteoporosis
metal implants

Endocrine/Metabolic:
Acromegaly
Addison's Disease
Adrenal Disorders
Cushing's Syndrome
De Quatrain's Thyroiditis
Diabetes
Gestational Diabetes
Goiters
Graves' Disease
Growth Disorders
Growth Hormone Deficiency
Hashimoto's Thyroiditis
Hyperglycemia
Hyperparathyroidism
Hyperthyroidism
Hypoglycemia
Hypoparathyroidism
Hypothyroidism
Low Testosterone
Menopause
Metabolic Syndrome
Obesity
Osteoporosis
Parathyroid Diseases
Pheochromocytoma
Pituitary Disorders
Polycystic Ovary Syndrome
Prediabetes
Silent Thyroiditis
Thyroid Diseases
Turner Syndrome
Type 1 Diabetes
Type 2 Diabetes

Integumentary:
Ulcers
eczema
psoriasis
skin breakdown
Cancer
Lupus
Fibromyalgia
Multiple Sclerosis
Arthritis
Shingles


EENT history:
ear problems
eye problems
nasal/sinus problems

Sexual/Reproductive history:
Abnormal bleeding/discharge
birth control
menopause
sexually active
sexually transmitted disease
recent pregnancy
currently pregnant

GI:
Appendicitis
Bowel obstruction
Esophagitis
Food poisoning
Hemorrhoids
Kidney disease
Kidney stones
Peptic ulcer
Peritonitis
Ulcer
Urinary tract infections (frequent or persistent)
Pancreatitis
Crohn's
Gastric Esophageal Reflux Disease
colostomy
Parkinson's
Gallstones
gastric bypass
rectal bleeding
Colitis
Diverticulitis
Liver failure

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