Khagen Singha

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—Khagen Singha—

Khagen Singha

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PERSONAL SPACE

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Patient name Age Gender Location / address Phone / contact Case date

Chief Complaint

Main Complaint

Associated complaints / Others

Duration of complaint

Causation (Ailments from)

Mind

Anger / Temper

Consolation

Company

Fears

Disposition / Temperament

Sympathetic

Generals

Thermal (Chilly / Hot)

Open air

Food Desires

Food Aversions

Thirst

Desire for drinks

Appetite

Stool

Urine

Sleep

Sleep position / habits

Dreams

Sweat

Physique / Body Build

Complexion / Skin Appearance

Habits / Addictions

Side affinity

Modalities

Aggravation (Worse by)

Amelioration (Better by)

Gynaecological (Female)

Menses

Leucorrhoea

History

Past history

Family history

Notes

Particular symptoms & modalities (location, sensation)

Examination / Vitals (BP, pulse, weight…)

Analysis / remedy considerations

Prescription

Prescription (Rx)

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