Risks, Predispositions, Notes of Concern Patient Intake Form Medical History (Hx

Question

Risks, Predispositions, Notes of Concern Patient Intake Form Medical History (Hx) Patient Information Name: ISex: F Age: 30 Assessment Age-related risk of disease? Charleston, SC Address: Occupation: Equestriarn Social History Occupational risk of disease? Risk of sexually transmitted infection (STI)? Reproductive status: No children/Sexually active -condoms, oral contraceptives Lifestyle factors Cat, dog, horses, goat Cigarettes; No drugs of abuse Travel: South Africa for 8 days 6 mo. ago Risk oftravel-related disease exposure? Risk ofvector-borne disease? Risk of drug-related disease exposure? Family History Schizophrenia (father) Medical History Allergies: Current medications: Presenting symptoms: Risk of genetic/familial disease? Shellfish Special concerns for treatment? NA Risk ofimmunocompromise? Seeking new medication Has sore throat, feels weak, headache, anorexia, insomnia, appears nervous

Explanation / Answer

Risk of vector borne disease *

May occur due to various pet animals whose infections may result in sore throat.

Risk of drug related disease exposure *

Exposure to contraceptive pills may produce side effects like nausea, vomiting, anorexia.

Risk of genetic/familial disease *

Family history of schizophrenia

Special concerns for treatment *

The risks are identified with *

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