Arun Patel shadow health Subjective Data
Chief Complaint
Finding: Established chief complaint
Finding: Reports coming in for check-up (Found)
History of Present Illness
Finding: Asked about relevant health conditions
Finding: Reports hypertension (Found)
Finding: Reports type 2 diabetes (Found)
Finding: Reports generalized anxiety disorder (Found)
Finding: Asked about onset and duration of associated symptoms
Finding: Reports increased worry (Found)
Finding: Reports increased thirst began 1 month ago (Found)
Finding: Reports increased urination began 1 month ago (Found)
Finding: Reports weight gain over the last 3 months (Found)
Finding: Reports fatigue and discomfort over the last 3 months (Found)
Finding: Asked about non-medicational diabetes management
Finding: Reports owning a glucometer (Available)
Finding: Reports checking blood sugar sporadically (Found)
Finding: Reports sporadic checking is because of disliking the glucometer’s pinch (Found)
Past Medical History
Finding: Asked about allergies
Finding: Denies known allergies (Found)
Finding: Asked about previous hospitalizations
Finding: Denies previous hospitalizations (Found)
Home Medications
Finding: Asked about home medications
Finding: Reports taking hydrochlorothiazide for hypertension (Found)
Finding: Reports taking metformin for type 2 diabetes (Found)
Finding: Reports taking escitalopram for anxiety (Found)
Finding: Denies taking vitamins and supplements (Available)
Finding: Followed up on hydrochlorothiazide
Finding: Reports taking hydrochlorothiazide with breakfast (Available)
Finding: Reports starting hydrochlorothiazide 1 year ago (Available)
Finding: Reports taking the last dose of hydrochlorothiazide this morning (Available)
Finding: Denies hydrochlorothiazide adverse effects (Available)
Finding: Followed up on metformin
Finding: Reports metformin tablets are each 500 mg (Found)
Finding: Reports taking metformin tablet twice daily (Available)
Finding: Reports taking metformin with meals (Available)
Finding: Reports starting metformin 5 years ago (Found)
Finding: Reports taking the last dose of metformin this morning (Available)
Finding: Denies metformin adverse effects
Focused Exam: Hypertension and Type 2 Diabetes Arun Patel shadow health Subjective Data
Subjective Data Collection: 20 of 20 (100.0%)
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Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.
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Found:
Indicates an item that you found.
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Available:
Indicates an item that is available to be found.
Category
Scored Items
Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
Not Scored
A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case. Focused Exam: Hypertension and Type 2 Diabetes Arun Patel shadow health Subjective Data
Chief Complaint
GET YOUR WORK DONE HERE
Finding:
Established chief complaint
Finding:
Reports coming in for check-up
(Found)
Pro Tip: A patient’s chief complaint establishes any illnesses or concerns they are presenting. Asking about the chief complaint will allow the patient to voice any concerns or symptoms the patient may have.Example Question:
What is your primary reason for this visit?
History of Present Illness
Finding:
Asked about relevant health conditions
Finding:
Reports hypertension
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing Focused Exam: Hypertension and Type 2 Diabetes Arun Patel shadow health Subjective Data.Example Question:
Do you have high blood pressure?
Finding:
Reports type 2 diabetes
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
Do you have diabetes?
Finding:
Reports generalized anxiety disorder
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
Do you have anxiety?
Finding:
Asked about onset and
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Example Question:
Have you been fatigued?
Finding:
Reports increased worry
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
Have you been excessively worrying?
Finding:
Asked about onset and duration of associated symptoms
Finding:
Reports increased thirst began 1 month ago
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
When did your thirst increase?
Finding:
Reports increased urination began 1 month ago
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
When did you start urinating more frequently?
Finding:
Reports weight gain over the last 3 months
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
When did you gain weight?
Finding:
Reports fatigue and discomfort over the last 3 months
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
How long have you felt ?
Finding:
Asked about non-medicational diabetes management
Finding:
Reports owning glucometer
(Available)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
Do you have a blood sugar monitor?
Finding:
Reports checking blood sugar sporadically
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
How often do you check your blood sugar?
Finding:
Reports sporadic checking is because of disliking the glucometer’s pinch
(Found)
Pro Tip: Asking a patient about the length of their current health issues solicits information relevant to the history of their present illness. Details of their current complaint will help you follow-up on any present conditions or symptoms, such as the location of their pain or the amount of pain they may be experiencing.Example Question:
How often do you check your blood sugar?
Past Medical History
Finding:
Asked about allergies
Finding:
Denies known allergies
(Found)
Pro Tip: Inquiring into the patient’s relevant history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.Example Question:
Do you have any allergies?
Finding:
Asked about previous hospitalizations
Finding:
Denies previous hospitalizations
(Found)
Pro Tip: Inquiring into the patient’s relevant history can reveal past diagnoses and previous conditions or concerns. Information about the patient’s existing health conditions, a timeline of diagnosis, symptoms, and allergies can indicate where you should follow-up for further care and treatment.Example Question:
Have you ever been hospitalized?
Home Medications
Finding:
Asked about home medications
Finding:
Reports taking hydrochlorothiazide for hypertension
(Found)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
Do you take any medication for your high blood pressure?
Finding:
Reports taking metformin for type 2 diabetes
(Found)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
Do you take any medication for your diabetes?
Finding:
Reports taking escitalopram for anxiety
(Found)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
Do you take any medication for your anxiety?
Finding:
Denies taking vitamins and supplements
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
What vitamins and supplements do you take?
Finding:
Followed up on…
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How often do you take hydrochlorothiazide?
Finding:
Reports taking hydrochlorothiazide with breakfast
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
How often do you take hydrochlorothiazide?
Finding:
Reports starting hydrochlorothiazide 1 year ago
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
When did you start taking hydrochlorothiazide?
Finding:
Reports taking last dose of hydrochlorothiazide this morning
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
When was your last dose of hydrochlorothiazide?
Finding:
Denies hydrochlorothiazide adverse effects
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
Do you experience any adverse effects from hydrochlorothiazide?
Finding:
Followed up on metformin
Finding:
Reports metformin tablets are each 500 mg
(Found)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
How much metformin do you take?
Finding:
Reports taking metformin tablet twice daily
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
How often do you take metformin?
Finding:
Reports taking metformin with meals
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
How often do you take metformin?
Finding:
Reports starting metformin 5 years ago
(Found)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
When did you start taking metformin?
Finding:
Reports taking last dose of metformin this morning
(Available)
Pro Tip: A patient’s home medications can provide insight into the patient’s current treatment and its efficacy. Inquiring into medication history, dosage, and frequency will help you understand the patient’s background and how it may affect their current situation.Example Question:
When was your last dose of metformin?
Finding:
Denies metformin adverse effects
