Observational Study

I.

Observational study PERSONAL INFORMATION 1. 2. 3. 4.

Name Age Sex Address

5. 6. 7. 8.

Education Occupation Monthly Income Caste and religion

II. HISTORY 1. Family History : - major illness,(Hereditary illness, and infectious illness) 2. Personal Health status: - (regarding factors contributing for the existing health status, G&D Pattern, Rearing etc.) 3. Socio – Cultural: - IPR in family, at work and society and attitude towards health practices. 4. Economic : - financial provision (specifically during illness) 5. Environment: - physical facilities available for living, risk factors in environment. 6. Past Illness History: - duration , treatment and result 7. Present Illness history: - chief complaint, duration, nature, treatment prior to hospitalization. 8. Medical Diagnosis: 9. Physical, Systemic, Specific Examination. ( for conformation of the subjective data) 10. Investigation: - to rule out the systemic pathological changes due to the illness. 11. Current Treatment: - Medicine, Surgery, Therapy 12. Progress: - Improvement, Stability or Deterioration 13. Summary: - Impression of self to the case, (because of the hospitalization, the quality of the care, the outcome are with in the expected limits or not)