Qureshi University, Advanced courses, via cutting edge technology, News, Breaking News | Latest News And Media | Current News
admin@qureshiuniversity.com

Admissions | Accreditation | Booksellers | Catalog | Colleges | Contact Us | Continents/States/Districts | Contracts | Examinations | Forms | Grants | Hostels | Honorary Doctorate degree | Instructors | Lecture | Librarians | Membership | Professional Examinations | Programs | Recommendations | Research Grants | Researchers | Students login | Schools | Search | Seminar | Study Center/Centre | Thesis | Universities | Work counseling

New Patient Consultation
Profile from birth until now
If your profile is available, you do not need to answer these questions.
If your profile is not maintained with me, you need to answer these questions.
If you have difficulty elaborating your profile, you can be helped with sample examples.
Annual health assessment of a child
Female
Yearly health assessment
Annual health assessment


What are the details of the problems or complaints you had in past one year?

_________________________

What are the details of the problems or complaints you think you will face in the years ahead?

_________________________

Do you have enough survival needs?

_________________________

What are details of your survival needs for next year?

_________________________

When was your last annual health assessment done?

_________________________

Who did your last annual health assessment?

_________________________

What were the findings?

_________________________

What were the recommendations?

_________________________

Did the recommendations help?

_________________________

Was it an annual health assessment or evaluation of a new problem?

_________________________

When did you last see a medical doctor?

_________________________

Did you see a medical doctor for an annual health assessment or a new problem?

_________________________

What seemed to be the problem?

_________________________

What was the diagnosis and treatment?

_________________________

What is the name and contact information of the medical doctor who gave you this diagnosis and treatment?

_________________________

How are you feeling today?

_________________________

Do you have any problems today?

_________________________

What seems to be the problem?

_________________________

_________________________

_________________________

_________________________

_________________________

Did you know that 90% of doctor visits are for stress related symptoms?

_________________________

What do you know about stress?

_________________________

What are the sources of medical history?

_________________________

Patient.
Family.
Patient not responding to medical history questions.
Community member.
Police officer.
Referral from medical doctor.
Other.

Where is the patient now?

_________________________

Where do you live now?

_________________________

What is your telephone number?

_________________________

What is your e-mail address or fax number?

_________________________

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. What best describes your problem?


_________________________

What is the reason for consultation?

_________________________

The new problem is not a medical emergency.
Follow-up medical consultation.
Problem that is a medical emergency (In case of a medical emergency, your local emergency service is the first responder. Guidelines for your local emergency responder are at this location: http:www.qureshiuniversity.com/emergencyworld.html).
Patient Education
Annual health assessment.
Patient been referred to you by others.
Patient been referred by you to others.
These are basic questions.
There are many more.

One copy of your yearly health assessment goes to the state department of health.
One copy of your yearly health assessment remains with your primary care physician.
Referred by:_________________________

How long have you known the patient?

______________________________________

What are the details of the primary health care physician of a resident/patient?

Primary Care Physician Name, Address and Phone:__________________

_______________________

_______________________

_______________________

_______________________
Here are helpful guidelines to describe your primary physician.

I do not have a primary health care physician.
My primary health care physician is not able to answer relevant questions via e-mail, fax, phone, postal mail, or face-to-face.
There are no competent primary care physicians in the area I am living.
I need a primary health care physician able to reach a correct diagnosis and treat me in various health care settings, and able to answer relevant questions via e-mail, fax, postal mail, and face-to-face.
Emergency Contact Name:______________

Phone: _______________________

Email Address: _______________________

Relationship:________________________
What is included in a yearly health assessment?
Survival needs screening.
Life stressors screening.
History from birth until now if not recorded previously.
Vision and hearing screening.
Any new complaints/problems.
Activities of everyday living, housekeeping, mobility screening.
Personality disorders screening
Screening physical exam.
Advice/recommendations.
What are findings about other medical doctors and health care providers?
Most of the medical doctors claiming to be highly specialized health care providers up to March 30, 2013 did not provide this type of yearly health assessment.

All medical doctors and health care providers are required to provide this type of quality yearly health assessment.

They should not call themselves specialists without at least quality yearly health assessment.

What type of health care screening is usually done but is not helpful and sometimes is harmful due to wrong results/false positives?
Cancer screening, PPD test, Elisa tests, etc.

Is this type of health care screening useful?
No.

Write down any symptoms you're having, including any that may seem unrelated to the reason for which you scheduled the consultation. Note when your symptoms bother you most — for example, if your symptoms tend to get worse at certain times of the day, during certain seasons, or when you're exposed to cold air, pollen or other triggers.

_________________________

_________________________

_________________________

Write down key personal information, including any major stresses or recent life changes.
_________________________

_________________________

Make a list of all medications, vitamins and supplements that you're taking.Take a family member or friend along, if possible. Sometimes it can be difficult to recall all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

_________________________

Write down questions to ask your doctor.

_________________________
Annual Physical Exam: The Basics

Date of Examination:_________________________

Physician Name:_________________________

Physician Address:_________________________
(For women only)
Are you pregnant or breast feeding? _____________________
Date of your last menstrual period: ______________________
How many children do you have? ______________________
How were they delivered? ______________________

Human Vital Signs

1. Consciousness:_________________________

2. Pulse rate:_________________________

3. Blood pressure:_________________________

4. Respiration rate:_________________________

5. Body temperature:_________________________

6. Emotion:_________________________

Vital Signs. These are some vital signs checked by your doctor:
Blood pressure: less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.
Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.
Respiration rate: Around 16 is normal. Breathing more than 20 times per minute can suggest heart or lung problems.
Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.

Vision & Hearing Screening

Height:_________________________

Weight:_________________________

Waist, hip circumferences:_________________________

BMI:_________________________

    Calculate the body mass index (BMI = wt (kg) ÷ ht(m2)
    < 20 BMI Low body weight
    20 to 25 BMI Healthy weight for most people
    >25 to 27 BMI Weight may lead to health problems
    27 to 29 BMI Overweight. Associated with increase in morbidity and mortality.
    > 30 BMI Obese
Eyes:_________________________

Ears/Nose:_________________________

Oral Cavity:_________________________

Endocrine:_________________________

Lymph Nodes:_________________________

Lungs:_________________________

Heart:_________________________

Breasts:_________________________

Abdomen:_________________________

Genitals:_________________________

Female Physical Exam:_________________________

Male Physical Exam:_________________________

Extremities / Musculoskeletal:_________________________

Habitus:_________________________

Skin:_________________________

Psychiatric:_________________________

Neurologic:_________________________

Laboratory Tests

Complete blood count

Chemistry panel

Urinalysis (UA)

Prescription