HISTORY
IDENTIFICATION
- Name
- Age
- Address
- Occupation
CHIEF COMPLAINTS
- Pain in the limb for ___ duration
- Ulcer over the foot for ___ duration
HISTORY OF PRESENT ILLNESS
Pain
- Duration
- Onset – gradual / sudden / following trauma
- Progress – improved / worsened
- Timing – throughout / intermittent
- Site / limbs affected
- Episodes & duration
- Character of pain