IDENTIFICATION

• Name
• Age
• Address
• Occupation

CHIEF COMPLAINTS

• Swelling in the ___ for ___

  (inguinal / scrotal / inguinoscrotal)

• Pain

HISTORY OF PRESENT ILLNESS

• Duration
• Onset
• Progress
• How did it start?
• Where did it appear first?
• Size and extent when first seen
• Disappearance on lying down?
• Pain
• History of intestinal obstruction