Internal Medicine History Taking Form

Save complete adult medical histories for ward rounds, OPD, case presentation, and revision.

Done By: Faisal Khalid Alshehri

Confidentiality warning: Do not enter real patient names, MRNs, national IDs, phone numbers, exact addresses, or hospital numbers. Use patient codes only, such as Patient A or M.A.

1. Student / Documentation Details

2. Patient Demographics

Avoid full names or MRN.

3. Chief Complaint

4. History of Present Illness

5. Symptom Analysis According to Complaint

6. Review of Systems

7. Past Medical and Surgical History

8. Medication and Allergy History

9. Risk Factors and Lifestyle

10. Family History

11. Social History and Supports

12. For Female Patients if Relevant

13. Examination Snapshot

14. Systemic Examination

15. Investigations

16. Assessment, Differentials, and Plan

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