RESEARCH PANEL

TAKE THE RECORDS / BEGIN TAKING HISTORY

Welcome to KHREWS Research Department!

We are glad to have you on board as researchers in our department. Your contributions to our research studies are invaluable, and we appreciate your dedication to advancing healthcare knowledge.

Taking Patient History: An Essential Step in Research

As researchers in our department, one of your primary responsibilities is to take accurate and comprehensive histories from patients participating in our studies. This information is crucial in helping us understand various health conditions, identify potential risk factors, and develop effective treatment strategies.

Using the Patient History Form

To ensure that all necessary information is collected, we have prepared a patient history form that contains a series of questions related to various health conditions. Your task is to ask the patients the questions in the form and record their answers accurately. Please make sure that every question is answered correctly, and do not hesitate to ask for clarification if you are unsure about any response.

Importance of Accurate Data Collection

Accurate data collection is essential in research, as it directly impacts the validity and reliability of our study findings. We rely on your attention to detail and commitment to collecting high-quality data to make meaningful contributions to healthcare research.

Thank you for your hard work and dedication. If you have any questions or concerns, please do not hesitate to reach out to us.

BEGIN THE RESEARCH TO

NAME OF STUDENT WHO IS TAKIG HISTORY / COLLECTING DATA *

UNIVERSITY NAME *

PHONE NUMBER OF STUDENT *

PERSONAL DATA OF PATIENT

PATIENT'S NAME *

Street Address *

City *

State/Province *

Country *

Gender *MALEFEMALE

How old are you? *

What is your marital status? *MARRIEDUNMARRIED

Phone *

PROFESSION? *

Lifestyle Habits

Do you exercise regularly? *YESNOT REGULARLY

How many hours do you sleep daily? *3-5 HOURS4-6 HOURS5-8 HOURS6-10 HOURS

MEDICAL HISTORY

Have you been hospitalized before? *YES IN SERIOUS MEDICAL CASESYES IN SMALL MEDICAL CASES ONLYNO

What Do You Think ,Why did You Get Chronic Disease ? *1. “I think my lifestyle choices, like not exercising regularly and smoking, have finally caught up with me. I wish I had made healthier choices earlier.”2. “I’ve been experiencing a lot of trauma and anxiety in my life, and I believe that’s weakened my immune system and made me more susceptible to this disease.”3. “I’ve always been a bit of a workaholic, and I think the constant pressure and stress have taken a toll on my body. I’m starting to realize that there’s more to life than just work.”4. “I’ve been taking medications for other conditions for years, and I wonder if those medications have contributed to my current condition. I feel like I’m stuck in a cycle of medications and side effects.”5. “I know I haven’t been eating the healthiest diet, and I think that’s contributed to my condition. I just love junk food too much!”6. “I’ve had a family history of this disease, so I guess it was only a matter of time before I got it too.”any other reason

Environmental Exposure

Are you exposed to pollution at work or home? *YESNO

Do you live near industrial areas or waste sites? *YESNO

Are you exposed to secondhand smoke? *YESNO

What is the quality of water in your area ? *GOODBAD

Family History

Do you marry in relations or outside ? *In RelationsOutside

Disease-Specific Questions

"Students, please take a thorough history from your patients using the following questions. When a patient reports a specific condition or symptom, proceed to the corresponding section to gather more detailed information. For example, if a patient mentions they have kidney disease, skip to the kidney disease section to ask additional questions. This will help you gather comprehensive information to better understand their health status and potential diagnoses.

CARDIOVASCULAR DISEASES

If you have experienced chest pain or discomfort before, please select the following questions to help us understand the location, radiation, duration, onset, and severity of the painSudden onset central crushing chest pain radiating to the left arm and/or jaw lasting longer than 20 minutes along with associated symptoms of sweating, clamminess, nausea and shortness of breath.Sudden onset central chest pain radiating to the left arm and/or jaw lasting fewer than 20 minutes with complete resolution of pain during rest ,associated symptoms include shortness of breath.Gradual onset of central chest pain worsened by lying flat and improved by leaning forwards,associated symptoms can include fever and fatigue.Gradual onset of sharp chest pain worsened by deep inspirationGradual onset of sharp chest pain worsened by deep inspiration, associated symptoms include productive cough, shortness of breath, feverGradual onset central chest pain that is typically described as burning in character and worsened by lying flat,associated symptoms can include nausea and vomiting.

If you have ever experienced irregular heartbeats (bradycardia, tachycardia, or other conditions), then please state the duration and frequency by answering the following questions.Irregular, rapid heartbeat that can be intermittent, long lasting, or permanent(Atrial Fibrillation)Regular, rapid heartbeat(Atrial Flutter)Rapid, regular heartbeat that begins and ends suddenly(Paroxysmal supraventricular tachycardia (PSVT)Rapid, regular heartbeat that can last for just a few seconds or much longer, which increases the risk of becoming ventricular fibrillation(Ventricular Tachycardia)Rapid, irregular heartbeat that causes the ventricles to quiver ineffectively instead of pumping blood (Ventricular fibrillation)

Have you experienced shortness of breath or fatigue during daily activities?Extreme fatigue and shortness of breath with minimal exertionChest pain or pressure during intense exerciseUnexplained dizziness or fainting during physical activitiesMild shortness of breath or palpitations during activitiesNo symptoms with physical exertion

Have you noticed any unusual swelling or fluid retention?Swelling in the legs, ankles, or abdomen, particularly after activitySudden and severe swelling in the feet or legs with a sense of heavinessMild, intermittent swelling that improves with elevation or medicationNo noticeable swelling or fluid retention

Have you been diagnosed with high blood pressure or high cholesterol?Yes, bothOnly high blood pressureOnly high cholesterolNo, neither

RENAL DISEASES

Have you ever noticed the blood, frequency, loss of control , pain during urine output, answer by selecting the following onePain when passing urine (dysuria)Passing blood in the urine (haematuria)Finding it difficult to pass urineBeing completely unable to pass urine (urinary retention)Passing urine unintentionally (incontinence)

Have you been diagnosed with any conditions that may affect kidney function, such as diabetes, high blood pressure, or obesity?HIGH BLOOD PRESSUREDIABETESOBESITYOTHER DISEASE

Have you experienced any pain or discomfort in your back, flank, or abdomen that may be related to kidney problems?FLANK PAINABDOMINAL PAINBACK PAINSIDE PAIN(RIBS & HIPS)

Have you had any previous kidney damage or disease, such as kidney stones, glomerulonephritis, or chronic kidney disease?Glomerulonephritisnephrotic syndromekidney stonekidney surgerykidney damagekidney infection

Have you taken any medications or supplements that may harm kidney function, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or certain antibiotics?NSAIDS( Ibuprofen, celecoxib)Antiobioticsany other medicine

DIABETES

1. Duration of symptoms and diagnosis: – Newly diagnosed diabetes (Type 1 or Type 2) – Uncontrolled diabetes – Diabetes with complications (e.g., nephropathy, retinopathy) 2. Diabetes medications: – Type 2 diabetes (if oral medications are prescribed) – Type 1 diabetes (if insulin is prescribed) – Insulin resistance (if metformin is prescribed) 3. Blood sugar monitoring: – Uncontrolled diabetes (if blood sugar levels are consistently high) – Hypoglycemia (if blood sugar levels are consistently low) – Brittle diabetes (if blood sugar levels fluctuate widely) 4. Diabetes-related complications: – Diabetic neuropathy (if nerve damage is present) – Diabetic nephropathy (if kidney damage is present) – Diabetic retinopathy (if vision problems are present) 5. Lifestyle changes: – Insulin resistance (if weight loss or dietary changes are not effective) – Metabolic syndrome (if multiple lifestyle changes are necessary) – Type 2 diabetes (if lifestyle changes are sufficient to manage blood sugar levels)

Have you been experiencing symptoms like increased thirst, frequent urination, or blurred vision, and when were you diagnosed with diabetes?Yes I have all of these SymptomsNo I Don’t Have these symptomsonly thirst & frequent urinationFeeling all these symptoms for about 2-3 monthsFeeling all these symptoms for about 4+ months

Have you been prescribed any diabetes medications, and if so, what type (oral, injectable, insulin) and for how long have you been taking them?Yes Oral MedicinesYes Insulin ( injectable)taking for about 3-4 monthstaking for about 5+ monthstaking for about an year agono medicine

Do you monitor your blood sugar levels regularly, and if so, what are your typical readings.Fasting: 120-150 mg/dLBefore meals: 100-140 mg/dLAfter meals: 150-200 mg/dLMore than above valuesless than above values

Have you noticed a any significant weight changes recently?yes my weight decreasedyes my weight increasedno changes noticed

Musculoskeletal & Rheumatological Disorders

Choose any of the following to describe the situation of lower back pain ,if anyChronic episodic mechanical lower back pain , backache related to standing/ walking a lot / sitting in one place & progressive stiffnessAcute onset while lifting/ bending/ sneezing / coughing, severe pain , sciatica , weakness and numbnessUrinary incontinence/ retention, feacal retention, saddle anaesthesia, bilateral leg pain and weaknessMorning stiffness> 30 minutes, pain worse on rest

Choose any of the following to describe the situation of Joint pain / stiffness / swelling ,if anySlowly progressive symmetrical polyarthropathy, small joints , deforming, early morning stiffnessIsolated swollen, hot , painful First MTP joint, hyperuricemiaAssociated skin plaques & nail changes , early morning stiffness, many patterns of joint involvementSymmetrical arthritis of lower limb joints & sacroiliac joints , early morning stiffness

Select any one of following:upper back looks rounded or hunched, back pain and stiffness, especially after sitting or standing for long periodsOne of my shoulders or hips seems higher than the other,clothes don’t fit evenly, and I notice a curve when I look in the mirrorMy lower back curves inward more than usual,I have lower back pain and find it uncomfortable to stand straight for a long time.Symmetrical arthritis of lower limb joints & sacroiliac joints , early morning stiffnessnone of above

Have you had any previous bone/muscle/joints surgeries, injuries, or infections, such as osteomyelitis?Bone injuries + surgeryDamage to muscleDamage to jointsDamage to Ligaments /Tendons

DERMATOLOGICAL DISEASES

Have you noticed any triggers that make your symptoms better or worse, such as sunlight, stress, or certain products?Sun ExposureHumidity drynessScratching / rubbingTopical Treatment/Lotions/ creamsHeat/Cold

GIT DISORDERS

1. Abdominal pain, nausea, vomiting, or changes in appetite or weight: – Gastroesophageal reflux disease (GERD) – Peptic ulcers – Inflammatory bowel disease (IBD) – Gastroparesis 2. Changes in stool or urine: – Gastrointestinal bleeding (e.g., ulcers, cancer) – Liver disease (e.g., cirrhosis, hepatitis) – Pancreatic disorders (e.g., pancreatitis, cancer) – Malabsorption syndromes (e.g., celiac disease, Crohn's disease) 3. Alcohol consumption or substance abuse: – Alcoholic liver disease (ALD) – Liver cirrhosis – Drug-induced liver injury – Pancreatitis 4. Previous stomach or liver conditions: – Recurrent peptic ulcers – Chronic hepatitis – Cirrhosis – Gastrointestinal cancer (e.g., stomach, liver, pancreas) 5. Medications or supplements that may affect the liver: – Drug-induced liver injury (DILI) – Hepatotoxicity – Liver damage due to herbal supplements (e.g., kava, ephedra)

What have you experienced like pain/ swelling /ascites in any part of abdomen?Pain( sharp/dull/tenderness to touch )Swelling ( hernias )Swelling ( Ascites)

Have you been diagnosed with any previous stomach or liver conditions, such as gastroesophageal reflux disease (GERD), peptic ulcers, hepatitis, or cirrhosis?Stomach DiseasesLiver DiseasesGERDGall bladder issuesIntestinal diseasesPancreas issues

Have you taken any medications or supplements that may affect the liver, such as acetaminophen, antibiotics, or herbal supplements, and if so, how long have you been taking them?AntibioticsNSAIDSHerbal SupplementsAnti Ulcer Medicines ( omeprazole )

NEUROLOGICAL DISEASES

Have you experienced any changes in your memory or cognitive abilities?Memory loss or forgetfulnessConfusion or disorientationDifficulty concentrating or making decisionsNo noticeable changes

Have you noticed any issues with movement or muscle control?Tremors or shaking at restMuscle stiffness or rigidityDifficulty walking or maintaining balanceNormal movement and coordination

Do you have any unusual sensations or pain?Numbness or tingling in limbsChronic headaches or migrainesSensitivity to light or soundNormal sensation and no pain

Have there been any changes in your mood or behavior?Increased anxiety or depressionMood swings or irritabilitySocial withdrawal or apathyStable mood and behavior

Are you experiencing any problems with speaking or swallowing?Slurred or slow speechDifficulty swallowing or chewingHoarseness or voice changesNo issues with speech or swallowing

Do you have any symptoms affecting your body's automatic functions?Dizziness or fainting spellsExcessive sweating or temperature intoleranceIrregular heart rate or blood pressure changesNo autonomic symptom

RESPIRATORY DISEASES

Have you been experienced with cough , wheezing , sneezing , shortness of breath?Dyspnoea: shortness of breathCoughthe coughing up of blood originating from the respiratory tract below the level of the larynxWheeze: a continuous, coarse, whistling sound produced in the respiratory airways during breathingChest pain: typically worsened by deep inspiration

Do you have a history of smoking or exposure to secondhand smoke, and if so, how many pack-years have you smoked?Yes I am a regular smokerExposed to second hand smokeNot a regular smokerSmoked for 6 monthsSmoked for 2 year +

Have you noticed any changes in your sputum, such as blood, rust-colored sputum, or thick yellow or green mucus?clear , white or graydark yellow or greenbrownpinkred

Have you been exposed to any environmental or occupational pollutants, such as asbestos, silica, or dust, and if so, how long and how often?Yes OccasionallyYes FrequentlyNot Regularly

CANCER

1. Unusual lumps, swelling, or pain: – Breast cancer (lump in breast or underarm) – Testicular cancer (lump in testicle) – Lymphoma (enlarged lymph nodes) – Soft tissue sarcoma (lump in soft tissue) 2. Changes in bowel movements, urination, or bleeding: – Colorectal cancer (blood in stool, changes in bowel movements) – Prostate cancer (changes in urination, blood in urine) – Bladder cancer (blood in urine) – Kidney cancer (blood in urine) 3. Family history of cancer: – Breast cancer (BRCA1 or BRCA2 mutation) – Ovarian cancer (BRCA1 or BRCA2 mutation) – Colorectal cancer (family history of colon cancer) – Prostate cancer (family history of prostate cancer) 4. Exposure to carcinogens: – Lung cancer (exposure to tobacco smoke or asbestos) – Skin cancer (exposure to UV radiation) – Mesothelioma (exposure to asbestos) – Leukemia (exposure to certain chemicals or radiation) 5. Changes in skin or moles: – Skin cancer (melanoma or non-melanoma) – Basal cell carcinoma (changes in skin) – Squamous cell carcinoma (changes in skin)

Select the following options to describe your situation.Chronic Fatiguepersistent pain not going awaynew moles on skinunexplained weight loss

Have you been exposed to any known carcinogens, such as radiation, certain chemicals, or asbestos, and if so, how long and how often?Yes OccasionallyYes FrequentlyNot regularlynever

Describe any other cancer disease not present in above optios.

HORMONAL DISORDERS

Have you experienced any changes in your menstrual cycle, such as irregular periods, heavy or light bleeding, or cessation of menstruation, and if so, how long have you been experiencing these symptoms?yes irregular periodsheavy bleedinglight bleedingcessationno change

Have you noticed any changes in your weight, appetite, or energy levels, such as unexplained weight gain or loss, increased hunger, or fatigue?weight gainweight lossloss of appetitefatigue / tiredness

Have you noticed any changes in your skin, hair, or nails, such as acne, hair loss, or brittle nails?hair lossbrittle nailsacne

Have you experienced any changes in your sexual function, such as decreased libido, erectile dysfunction, or decreased fertility.erectile dysfunctiondecreased fertilitydecreased libido

Have you experienced any changes in your mood, such as depression, anxiety, irritability, or mood swings?depressionanxietymood swings

OPHTHALMIC DISORDERS

Does it feel like you've got something stuck in the eye?Yes, constantlyYes, occasionallyNo, my eyes feel fine

ENT DISORDERS

1. "Do you experience any hearing loss, ringing, or fullness in your ears?" – Answer: Yes, I've had hearing loss and ringing in my left ear for months. – Potential diagnosis: Sensorineural Hearing Loss, Tinnitus, or Acoustic Neuroma 1. "Have you had any nasal trauma, surgeries, or sinus infections in the past?" – Answer: Yes, I had a nasal fracture last year. – Potential diagnosis: Nasal Septal Deviation, Chronic Sinusitis, or Nasal Polyps 1. "Do you experience any difficulty swallowing, hoarseness, or throat pain?" – Answer: Yes, I've had hoarseness and throat pain for weeks. – Potential diagnosis: Laryngitis, Vocal Cord Nodules, or Thyroiditis 1. "Have you noticed any ear discharge, itching, or pain in your ears?" – Answer: Yes, I've had ear discharge and itching for days. – Potential diagnosis: Otitis Externa (Swimmer's Ear), Middle Ear Infection, or Mastoiditis 1. "Do you experience any postnasal drip, coughing, or sneezing?" – Answer: Yes, I've had postnasal drip and coughing for months. – Potential diagnosis: Allergic Rhinitis, Chronic Rhinitis, or Gastroesophageal Reflux Disease (GERD)

Describe Your situation by selecting the best option .Throat Pain while swallowing & breathingpain , hearing loss , discharge & balance problems in yearsneezing , runny nose , headacheoverweight , enlarged tonsils, snoring , waking up with dry throat

What do you experience like hearing loss, ringing, or fullness in your ears?Yes Frequently I feel ringing in my earsYes Frequently I feel fullness in my earsHearing lossnone

"Have you had any nasal trauma, surgeries, or sinus infections in the past?"yesno

"Do you experience any difficulty swallowing, hoarseness, or throat pain?"yesno

"Do you experience any postnasal drip, coughing, or sneezing?"YesNo

LIVER DISEASES

Have you experienced any recent jaundice or yellowing of the skin and eyes?Yes, severe and persistentYes, occasionallyNo, but I have noticed a slight yellowingNo, I haven’t experienced any yellowing

Do you have a history of abdominal pain or discomfort, particularly in the upper right quadrant?Yes, frequently and severeYes, occasionallyNo, but mild discomfort at timesNo, pain is not a concern

Do you have a history of abdominal pain or discomfort, particularly in the upper right quadrant?Yes, dark urine and pale stoolYes, pale urine and dark stoolNo significant changeSlight changes in color

Have you noticed any symptoms of chronic fatigue, unexplained weight loss, or loss of appetite?Yes, all symptoms are presentYes, experiencing fatigue and weight lossYes, experiencing fatigue but no weight lossNo symptoms or mild appetite loss

Choose the best option which describes your stage.Jaundice, dark urine, pale stool, fatigue, abdominal pain, loss of appetite, nausea, vomiting, fever.Fatigue, abdominal discomfort, ascites, mild jaundice, changes in appetite, weight loss.aundice, severe ascites, easy bruising, itchy skin, dark urine, pale stool, hepatic encephalopathy, spider angiomas, swelling in legs and ankles.– Persistent jaundice, ascites, hepatic encephalopathy, severe leg and abdominal swelling, decreased liver function, complications like kidney failure or infections.

ANY OTHER DISEASE

WRITE THE DETAILS OF ANY OTHER DISEASE( SYMPTOME/CAUSES)