CLINICAL CASE RECORD (§ 83-104)
Date: IPD/OPD Reg. No.:
Preliminary data:
Name: Religion:
Age: Marital Status: Sex:
Occupation: Address:
CHIEF COMPLAINT:
LOCATION SENSATION MODALITY CONCOMITANT
ODP:
ASSOCIATED COMPLAINTs: L/S/M/C (with ODP)
PATIENT AS A PERSON (§ 5, 94, 208)
A) APPEARANCE: Lean/Stocky/Obese:
B) APPETITE:
Veg/Non-veg: Food/Drink >/<:
Craving: Thirst:
Aversion: Habit:
C) ELIMINATIONS:
Urine: Stool:
Perspiration:
D) MENSTRUAL FUNCTIONS:
1) FMP LMP:
Duration: Cycle:
Quantity: Color/stain:
COMPLAINTS: Before:
During:
After:
2) OBSTETRIC HISTORY: G P A L
3) LEUCORRHOEA:
4) MENOPAUSE:
E) CHILD DEVELOPMENT AND GROWTH:
Birth milestones and problems: Teething:
Birth weight: Walking:
Talking: Congenital/infantile problem:
H/O pica: Vaccination:
F) THERMAL STATE:
1) Covering/uncovering: 5) Open air:
2) Bath: 6) Sun:
3) Dampness: 7) Air conditioner:
4) Fan:
HOT/AMBITHERMAL/CHILLY
PAST HISTORY WITH TREATMENT (IN CHRONOLOGY):
FAMILY HISTORY:
MENTALS: (Disposition, State, Expressions and Life History) § 6. 211, 230
SLEEP: DREAMS:
GENERAL EXAMINATION:
Temperature: Respiratory Rate:
Pulse: B.P.:
Others:
Pallor/icterus/cyanosis/clubbing/lymphadenopathy/oedema
SYSTEMIC EXAMINATION:
RS CVS GIT GUS CNS
Inspection:
Palpation:
Percussion:
Auscultation:
INVESTIGATIONS:
CASE PROCESSING
DIFFERENTIAL DIAGNOSIS:
DIAGNOSIS OF THE DISEASE: (§ 5, 72-82, 173-245)
DIAGNOSIS OF THE MIASM: (§5, 75-82) and SUSCEPTIBILITY (§ 28, 20, 32, 117)
Miasm - Fundamental: Dominant:
Susceptibility: (State high/low)
TOTALITY: ACUTE: (§73, 152, 153)/CHRONIC: (§ 145/245)
DIAGNOSIS OF REMEDY (§ 245-248, 279, 285) WITH POTENCY AND REPETITION:
GENERAL MANAGEMENT/DIET AND REGIMEN:
