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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).

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

Also useable is SOCRATES

Medicare definitions

CMS required history elements[11]
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

See also

References

  1. ^ 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.
  2. ^ Evaluation and Management Coding and Electronic Health Records
  3. ^ http://www.usc.edu/health/uscp/compliance/tm6.html#6
  4. ^ Medical Assessment
  5. ^ Learning To Perform a Medical Assessment – Part 1: Quick Medical Assessment
  6. ^ WEMSI - Assessment by PQRST
  7. ^ Department of Medicine Home Page
  8. ^ Dartmouth Medicine Magazine :: Student Notebook
  9. ^ HPI (history of present illness)
  10. ^ Buring SM, Kirby J, Conrad WF (2007). "A structured approach for teaching students to counsel self-care patients". Am J Pharm Educ. 71 (1): 8. PMC 1847542. PMID 17429508. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ "Evaluation and Management Services Guide" (PDF). www.cms.gov. December 2010. Archived from the original (PDF) on 2012-04-11. Retrieved 2011-02-27.

External links

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