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What should I know about you?
Patient Profile |
| Profile Questions |
| Medico legal case |
| Medical Record |
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What are the parameters that determine the elements of effective case management with regard to a human being?
Age Abilities/skills Address from birth until now Assets Complaint or issue type Duties, if any Emergency issues, if any Educational level Family/relationship Gender Law applicable to specific scenarios Location of individual at this point Languages abilities Normal day State and outside state travel Profession Products or services abilities Recommendations These parameters determine elements of case management Who has your medical record? Can I get a copy of your medical record? If you do not have a medical record and need to be my patient, a new medical record needs to be created. This will take a few weeks. You need to forward details about yourself. This will be followed by various specific questions. |
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Your Personal Profile – The facts about me
My full name is _____ I was born on _____(day/month/date) I am a _____ __________ and this makes me feel _____ My star sign is _____ My parents are _____ I have _____ siblings (if you have them!) I am currently at _____ school / university / college or I currently work at _____ What I like about my school studies / job is _____ What I dislike about my school studies / job is _____ I am _______ up for _____ because _____ My home is in _____(place) and I have lived here for _____(years) My friends are _____ (names and descriptions) I love people who _____ (take risks / tell funny stories, etc.) My favorite activity/activities include _____ and I love to do this because _____ My favorite color is _____ because it reminds me of _____ I love to say _____ and my most over-used saying is probably _____ My favorite meal involves _____ and my favorite snack food is _____ I consider myself to be _____ (healthy/unhealthy) and fitness _____ is/is not important to me. This is due to factors such as _____ Changes to my lifestyle I would like to make include _____ I am _____ (clean/messy/organized/chaotic) I lose/don't lose things I don't need to change anything about my life or lifestyle because _____ The person who supports me the most is _____ and in my life they have helped me to _____ The best time of the day to me is … because _____ I like _____ (sunrise/sunset) the most because _____ I need to have _____ every day I hope to hear _____ (music/bands/a phrase/poetry/a speaker) I want to see _____ (films/shows/flowers/nature, etc.) I am frightened by _____ (snakes/cockroaches/bills/the dark) and this makes me _____ My favorite movie of all time is _____ My greatest inspiration is _____ My all-time role model is _____ because _____ I would like to be like … because _____ I respect _____ because (he/she) ______ MY PAST When I was little I remember that _____ I felt _____ (happy/sad or other emotions) My childhood was generally _____ (positive/negative, etc.) and this is because _____ My family is _____ (amazing/crazy/sad/wonderful/split up. etc.) and this is because _____ The good times I remember were _____ The hard times I can remember include _____ I find / always found school to be _____(easy/difficult/fun, etc.) and this is because _____ The best teacher I ever had was _____ because he/she _____ and that made me realize that _____ The worst teacher I ever had was _____ because he/she _____ and that made me realize that _____ The music I like to listen to is _____ because it sounds like _____ and makes me feel _____ I grew up thinking that _____ I changed when _____ The first concert event I ever went to was _____ (band/event) at the _____ (place) and I went with _____ I found the experience of being in a large crowd to be _____ (description) The best holiday I ever had was _____ when I went to _____ with _____ and we ______ (description) The best thing anyone has ever said to me is _____ The worst thing anyone has ever said to me is _____ What no one has ever told me is _____ My first crush on someone was _____ because _____ and it happened when _____ because _____ The first time someone had a crush on me was _____ and it felt _____ because _____ and it turned out to be _____ because _____ The most fun I ever had was when _____ and _____ because _____ In the past I have been hurt by _____ when _____ because _____ In the past I have hurt _____ when I _____ because ______ and I feel ______ about it My most successful day was when I _____ I received recognition when I (graduated/won a prize/got a job/moved out, etc.) I am proud that I _____ I look back at my life and I feel that _____ because _____ The greatest lesson I learned was _____ and I learned it when _____ The wisest thing anyone ever told me was _____ and it helped me to _____ The first time I was scared was when _____ The last time I went out was ______ The highlight of my school years was _____ The greatest risk I ever took was when I ______ The best result I ever got was when I _____ The worst thing that ever happened to me was ______ The peak experience of my teen years was _____ The craziest thing that ever happened to me was ______ The funniest thing that ever happened to me was ______ The last thing I purchased was _____ MY FUTURE In my teens I hope to achieve _____ In my twenties I hope to achieve _____ In my thirties I hope to achieve _____ In my forties I hope to achieve _____ When I am older I would like to be _____ When I am older I would like to do _____ I would love to travel to _____ because _____ I think marriage is _____ I would like/would not like (to be married/to be single/living in a share house/living alone) I think children are (awesome/a great thing/a burden/unnecessary, etc.) and I would like to/not like to have children/adopt children I think having a career is _____ and I would like to be _____ so that I can _____ with my life The goals I have include _____ I am looking forward to _____ I am worried about _____ I am confident that _____ I feel uncertain of _____ I know for sure that _____ MY PRESENT I love _____ I believe _____ I am happy when _____ I feel comfortable in _____ I need to _____ I think that _____ I have an instinct about _____ My dreams are _____ It is important to _____ I am upset about _____ I find these things _____ funny/hilarious I find these things _____ sad/devastating I am joyful about _____ I am waiting until _____ before I _____ I am in love with _____ because _____ I am grieving abut _____ I am concerned that _____ I am conflicted by _____ I am confused that _____ I am angry that _____ I am sorry about _____ I am interested in _____ I am thrilled by _____ I would like to be _____ I would like to have _____ I would like to change _____ I am scared that _____ My most secret desire is _____ I like it when _____ I dislike it when _____ I love how _____ I hate it when _____ I have the strangest feeling that _____ I find _____ beautiful and it _____ I think that I cannot _____ I find _____ ugly as it _____ I think _____ is silly because _____ I think _____ is tragic because _____ What no one realizes about me is _____ I see _____ I find it easy to _____ I find it hard to _____ I am at my best when _____ I can do _____ I am tired of _____ I am excited by _____ I hope that _____ My destiny is _____ What is the “reported” chief complaint(s)? What is the setting? What is the Patient’s General Appearance? Are there medications or therapies present or in- use? Are medical documents or files available? What seems to be the problem today? What can I help you with today? Does the patient really understand your questioning? Can the patient actually read? Could some of these be chronic issues? Does anyone present make the patient feel uncomfortable? Why is this patient experiencing these signs/symptoms? |