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A - S - K Homoeopathic Clinic. Acute Case No.

The document outlines a template for patient intake at A|S|K Homoeopathic Clinic, including sections for acute and chronic cases. It collects essential patient information such as name, age, contact details, medical history, chief complaints, and physical general observations. The template is designed for use by Dr. Ashwini Krishna Walke, a consulting homeopath.

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Aniket Walke
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60 views5 pages

A - S - K Homoeopathic Clinic. Acute Case No.

The document outlines a template for patient intake at A|S|K Homoeopathic Clinic, including sections for acute and chronic cases. It collects essential patient information such as name, age, contact details, medical history, chief complaints, and physical general observations. The template is designed for use by Dr. Ashwini Krishna Walke, a consulting homeopath.

Uploaded by

Aniket Walke
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

A|S|K HOMOEOPATHIC CLINIC.

ACUTE CASE NO. [ ]


DR.ASHWINI KRISHNA WALKE
[CONSULTING HOMOEOPATH]. DATE :

NAME: AGE:
SEX:
ADDRESS:
TEL/MOB:
DATE OF BIRTH:
WT:
BP:

K/C/O:

CHIEF COMPLAINTS : SINCE WHEN:


LOCATION SENSATION MODALITIY

ALIMENTS FROM :

PHYSICAL GENERALS:

THIRST :
DESIRE:
SLEEP:
TASTE:
TONGUE :
FEVER :
HEAT STAGE CHILL STAGE PERSPIRATION MODALITIES
RECURRENT COMPLAINTS :

THERMALS:

A|S|K HOMOEOPATHIC CLINIC CHRONIC


CASE NO. [ ]
DR. ASHWINI .K. WALKE DATE:
[ CONSULTING HOMOEOPATH]

NAME : Age:
sex:
Address:
Tel/mob:
Date of birth:
Wt:
BP:

K/C/O:
1] 3]
2] 4]

CHIEF C/O: SINCE WHEN:

LOCATION SENSATION MODALITIY

ALIMENTS FROM :
INVESTIGATION :

PHYSICAL GENERALS:

• HABIT
• DIET
• DESIRE : SWEET, PUNGENT,SPICY, SOUR, TEA, NON-VEG,COFFEE,
FATTY FOOD
• THIRST: LQSI,SQLI

L S
M
HEAD/HAIR C/O
EYES
EARS
NOSE
MOUTH TONGUE
TEETH
THROAT
STOMACH ACIDITY
CHEST
SKIN
URINE
BOWEL
SLEEP
PERSPIRATION

UPPER/LOWER EXTREMITIES :

FEMALE COMPLAINTS:
OBS.H/O: FTND/CAESAREAN

MIND COMPLAINTS :

ANY IMPACT:

THERMALS:

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