SHADOWHEALTH HEENT SUBJECTIVE
Subjective Data Collection: 32 of 32 (100.0%) Hover To Reveal...
Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.
Found: Indicates an item that you found.
Available: Indicates an item that is ava...
shadowhealth heent subjective subjective data collection 32 of 32 1000 hover to reveal hover over the patient data items below to reveal important information
including pro tips and example q
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SHADOWHEALTH HEENT SUBJECTIVE
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SHADOWHEALTH HEENT
SUBJECTIVE
Subjective Data Collection: 32 of 32
(100.0%) Hover To Reveal...
Hover over the Patient Data items below to reveal important information, including Pro Tips and
Example Questions.
Found: Indicates an item that you found.
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.
Relevant Medical History
Finding: Asked about history of headache
Finding: Reports occasional headaches (Found)Pro Tip: Sinus problems can result in increased pressure
buildup and headaches. Asking Tina if she gets headaches is soliciting information about possible
symptoms that she experiences.Example Question:Do you get headaches?
Finding: Asked about frequency and/or duration of headaches
Finding: Headaches occur once a week (Found)Pro Tip: Establishing a timeline for how often Tina gets
headaches will illustrate how long she has been suffering these particular symptoms and might indicate
possible triggers.Example Question:How frequently do your headaches occur?
Finding: Headaches last "a few hours" (Found)Pro Tip: Establishing a timeline for how long Tina's
headaches last will illustrate how long she has been suffering these particular symptoms and might
indicate possible triggers.Example Question:For how long do your headaches last?
Finding: Asked about character and location of headaches
, Finding: Describes headaches as tight and throbbing (Found)Pro Tip: Follow-up questions will enable
Tina to more fully and specifically describe her condition, experience, or symptoms.Example
Question:What do your headaches feel like?
Finding: Describes headache location as behind her eyes (Found)Pro Tip: Specifying the location of
pain can narrow and define where Tina's pain is occurring. Soliciting this information allows you to
more accurately treat her symptoms.Example Question:Where do you feel your headaches?
Finding: Asked to rate headache pain on a scale
Finding: Rates headaches as a 2 or 3 (Found)Pro Tip: Pain severity might change for a variety of
reasons. Asking Tina to rate the severity of her pain on a scale of 1-10 will provide a quantified and
relative measurement of her condition.Example Question:On a scale of 1 to 10, how bad are your
headaches?
Finding: Asked about headache treatment
Finding: Reports treating headaches with Tylenol (Found)Pro Tip: Tina's response to a question about
managing her headaches will reveal the severity of her symptoms, her health literacy, and the way she's
complied with previous treatment plans.Example Question:Do you take anything to treat your
headaches?
Finding: Reports Tylenol and rest usually resolve symptoms (Found)Pro Tip: Tina's response to a
question about managing her headaches will reveal the severity of her symptoms, her health literacy,
and the way she's complied with previous treatment plans.Example Question:Does the Tylenol help
with your headaches?
Finding: Asked about headache triggers
Finding: Reports headaches only happen when reading or studying (Found)Pro Tip: Follow-up
questions will enable Tina to more fully and specifically describe her condition, experience, or
symptoms.Example Question:When do you get headaches?
Finding: Reports that blurry vision and headaches often coincide (Available)Pro Tip: Follow-up questions
will enable Tina to more fully and specifically describe her condition, experience, or symptoms.Example
Question:Do your headaches coincide with your blurry vision?
Finding: Asked about vision problems
Finding: Reports occasional blurry vision (Found)Pro Tip: Broad, open questions will allow Tina to
describe, in her own words, the specific pain and discomfort that she is experiencing.Example
Question:Have you been having problems with your vision?
Finding: Asked about character of blurry vision
Finding: Describes blurry vision as "fuzzy letters" (Found)Pro Tip: Broad, open questions will allow Tina
to describe, in her own words, the specific pain and discomfort that she is experiencing.Example
Question:What's your blurry vision like?
Finding: Asked about onset and frequency of blurry vision
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