Pediatric review of systems template

Nasal Congestion …… c. Mouth Sores …… d. Sore Throat ……. Cough …… b. Wheezing …… c. Difficulty Breathing ……. Chest Pain …… b. Palpitations …… c. Cramping in Thighs …… d. Peripheral Edema ….. Abdominal Pain …..

Nausea …… c. Abdominal Pain …… d. Diarrhea ……. Muscle Pain …… b. Back Pain …… c. Joint Pain …… d. Restricted Motion ……. Rashes …… b. Sores …… c. Blisters ……. Depression ……. Anxiety ……. Sleep Disturbances ……. Suicidal Thoughts ……. Heat Intolerance …… b. Cold Intolerance …… c.

Excessive Thirst ……. Headaches …… b. Light Headaches ….. Dizziness ……. Bleeding …… b. Abnormal Bleeding ……. Allergic Reaction ….. Respiratory: The patient denies shortness of breath, wheeze, cough or hemoptysis. Denies nausea, vomiting, dysphagia, abdominal pain, constipation or diarrhea. The patient has amenorrhea for last 3 years. Musculoskeletal: The patient denies muscle weakness.

The patient denies pain or joint stiffness. The patient denies restriction of range of motion. SKIN: No rashes or jaundice. All other systems reviewed and are negative. Does not take anything for it. It only lasts for an hour or two and she is not sure what precipitates the headache. She feels that she does not know how much fluid she takes. Denies any caffeine use and she states these headaches are not new.

She has had them for as long as she can remember. No lightheadedness or dizziness. No chest pain or shortness of breath. No cough, wheeze. No fever. No heartburn symptoms. No nausea or vomiting. She is happy with her weight. No constipation. No diarrhea. No genitourinary symptoms.

No skin changes, rashes or lesions. Depression: She shrugs her shoulders and states she is not depressed and she denies anxiety. She says she sleeps well at night most of the time.

Skin: The patient denies itching rashes, sores and bruises. The patient denies headache, nausea, vomiting, visual changes. Respiratory: The patient denies shortness of breath, wheeze, cough, and hemoptysis.

Cardiac: The patient denies chest pain and palpitation. Urinary: The patient complains of frequent urination. No blood in urine. No urine retention. No pain during urination. The patient usually goes to the bathroom during the night 2 to 3 times, during the daytime 3 to 4 times. Denies pain, joint stiffness. The patient complains of low back pain radiating to the left lower extremity with numbness of the left lower extremities and episodes of weakness of the left lower extremities.

The patient has restriction of range of motion at the lumbosacral spine on flexion and extension. Skin: The patient complains of itching, rash on both lower extremities, located on anterior shins.

No bruises and no ulceration. Eye, ears, nose, sinuses, mouth, throat and neck: No complaints. Respiratory: Denies shortness of breath, wheeze, cough, and hemoptysis. Cardiac: Denies chest pain or palpitation. Urinary: Has normal urination. How to fill out and sign XL online? Follow our easy steps to have your Pediatric Review Of Systems prepared quickly: Select the template from the library. Complete all required information in the required fillable fields.

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