HealU Clinic
Doulatpur, Harishchandrapur , Malda
West Begal- 732125 || www.healuclinic.com
Health Assessment Sheet
Date - 29/01/23
Health Information :
Medical History :
Name :
sahil akhter
Chronic Health Problems :
diabetes
Age/Sex/Relationship:
18/male/single
Previously Consulted :
yes
Wt / Ht/ BMI :
65kg/135cm/20
Provisional Diagnosis :
ASTHMA
BP/RR/TEMP :
120-80/13/95f
Previous Investigations :
X-RAY
Pulse/ Pulse OX :
72 /90
On Medications :
YES
Job/Lifestyle :
Addiction :
FARMER/LABOURIUS
alcohol
Medicine || Dust Allergy :
YES || NO
Food Habit :
Appetite :
non-veg
Decreased
Last Checkup :
Major Surgery :
1 MOnths Ago
No
Symptoms Assessment
Pain
Headache
Throat Pain
Since | Onset:
2 months | Gradual
Since | Onset:
2 months | Gradual
Since | Onset:
2 months | Gradual
Severity :
Moderate
Severity :
Moderate
Severity :
Moderate
Timing:
night
Timing :
night
Timing :
night
Worsens On :
Dust , Cold
Worsens On :
Dust , Cold
Worsens On :
Dust , Cold
Better By :
Gargle
Better By :
Gargle
Better By :
Gargle
Symptoms :
Sneeze
Symptoms :
Sneeze
Symptoms :
Sneeze
Symptoms :
Sneeze
Symptoms :
Sneeze
Symptoms :
Sneeze
Sputum Type :
Whbeezing
Sputum Type :
Whbeezing
Sputum Type :
Whbeezing
Color :
white
Color :
white
Color :
white
Blood In Cough :
No
Headache With Vomiting:
No
Itching :
NO
Blood In Cough :
No
Headache With Vomiting:
No
Itching :
NO
Blood In Cough :
No
Headache With :
No
Itching :
NO
- Current Medication:
back pain
- Latest Investigations:
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Physical examination
inspection
No DATA
Palpation
No DATA
Percussion
No DATA
auscultation
No DATA
