BIODATA
1-name ………………..
2- age ……………….
3- sex …………………
4- nationality …………………….
5- admitted since ……………… through …………….
6-complaining of ……………………….. since ……………………………..
7- site …………………
8- mode of onset……………. Duration ……………frequency……………
Sverity ……………..
9- nature (character) ……………………
10-progression ………………….
11-relieving factors ……………………
12-aggravating factors …………….
13-radiation …………………..
14-associated symptoms ………………….
15- past medical history ……………………
16-past surgical history …………………….
17-common diseases ;
DM , HTN , Asthma , TB , Cardiac , Renal or Liver Diseases
18-drug history ……………………..
19-allergic history ………………………
20-blood transfusion history : yes no
21-vaccination history: yes no
22-childern: yes no number:
23-occupation…………………………..
24-income ……………………………
25-education …………………
26-Habitatnt ………………….
27-smoking yes no
28-alcoholic yes no
29-travelling history ………………………………………
Similar illness in the family and onset
الرئيسية 
