History of the present illness
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Not to be confused with Past medical history.
In a medical encounter, a history of the present illness (abbreviated HPI)[1] (termed history of presenting complaint (HPC) in the UK) refers to a detailed interview prompted by the chief complaint or presenting symptom (for example, pain).
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[edit] Questions to include
Different sources include different questions to be asked while conducting an HPI.
Several acronyms have been developed to categorize the appropriate questions to include.
The Centers for Medicare and Medicaid Services has published criteria for what constitutes a reimbursable HPI. A "brief HPI" constitutes one to three of these elements. A "extended HPI" includes four or more of these elements.[2][3]
| CMS | "OPQRST"[4][5] or "PQRST"[6][7] |
"CLEARAST"[8] | "LIQOR AAA"[9] | "SCHOLAR"[10] ("S" = Symptoms) |
|---|---|---|---|---|
| location | "R": Region and Radiation | "L": Location | "L": Location | "L:" Location |
| quality | "Q": Quality of the pain | "C": Character | "Q": Quality | "C:" Characteristics |
| "R": Radiation | "R": Radiation | see above | ||
| severity | "S": Severity | "S": Severity | "I": Intensity | see above |
| duration | "O": Onset | "T": Time frame | "O": Onset | "O:" Onset "H:" History |
| timing | "T": Time | see above | see above | see above |
| context | ||||
| modifying factors | "P": Provocation or Palliation | "E": Exacerbation | "A": Aggravating factors | "A:" Aggravating factors |
| "A": Alleviation | "A": Alleviating factors | "R:" Remitting factors | ||
| associated signs & symptoms | "A": associated symptoms | "A": Associated symptoms | see above |
[edit] Medicare definitions
| Type of history | CC | HPI | ROS | Past, family, and/or social |
|---|---|---|---|---|
| Problem focused | Required | Brief | N/A | N/A |
| Expanded problem focused | Required | Brief | Problem pertinent | N/A |
| Detailed | Required | Extended | Extended | Pertinent |
| Comprehensive | Required | Extended | Complete | Complete |
[edit] See also
[edit] References
- ^ Adler HM (1997). "The history of the present illness as treatment: who's listening, and why does it matter?". J Am Board Fam Pract 10 (1): 28–35. PMID 9018660.
- ^ Evaluation and Management Coding and Electronic Health Records
- ^ http://www.usc.edu/health/uscp/compliance/tm6.html#6
- ^ Medical Assessment
- ^ Learning To Perform a Medical Assessment – Part 1: Quick Medical Assessment
- ^ WEMSI - Assessment by PQRST
- ^ Department of Medicine Home Page
- ^ Dartmouth Medicine Magazine :: Student Notebook
- ^ HPI (history of present illness)
- ^ Buring SM, Kirby J, Conrad WF (February 2007). "A structured approach for teaching students to counsel self-care patients". Am J Pharm Educ 71 (1): 8. PMC 1847542. PMID 17429508. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1847542.
- ^ "www.cms.gov". http://www.cms.gov/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf. Retrieved 2011-02-27.
[edit] External links
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