| IMMUNOLOGY |
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Allergies, also see ALLERGIES |
allergen prick skin tests |
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bee venom reaction |
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immunisation history |
tetanus immunisation when |
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triple antigen immunisation when |
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other |
autoantibodies |
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HLA A, A2, B, B2 |
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immunoglobulin A, G, M |
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rubella titre |
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tetanus antibodies |
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| INJURY |
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broken bone |
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broken bone details |
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chest injury/operation, ever had |
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hand injury |
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have many accidents? |
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any injuries last 3 yrs? |
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| MEDICATION |
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all drugs currently used (detailed) |
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analgesics |
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antacids, med name, when started, how long took |
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antihistamines |
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asthma medication/"drugs for asthma" |
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asthma medication detailed |
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beta agonist sprays, tablets or syrup? |
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calcium (detailed) |
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diabetes - tablets |
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diabetes - insulin |
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diuretics (detailed) |
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drug allergy |
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drug reactions |
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epilepsy medication (detailed) |
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hrt |
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hrt (detailed) |
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hypertension trt |
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oral contraceptives |
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steroids |
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taking drugs |
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theophylline compounds |
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thyroid medication |
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ulcer & anti inflammatory drugs |
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vitamin D tablets (detailed) |
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| MEMORY |
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memory questionnaire |
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mimi-mental state questionnaire |
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| MISCELLANEOUS |
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in good health now? |
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any disease or incapacity |
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right/left-handed |
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use sunscreen cream |
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polyuria |
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ever donated blood |
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activities of daily living questionnaire |
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| OCCUPATIONAL HISTORY |
1966 |
1969 |
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occupation |
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history of dusty job |
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work hours light, moderate & vigorous activity |
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work involves perspiring |
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exposed to tobacco smoke at work |
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<-Page 4| Back to topics| Page 6->