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[DOC File]PATIENT INFORMATION
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NONE / hearing loss / ringing / ear pain / change in sense of smell / runny nose / post nasal drip / nose bleeding / sores in the mouth / sore throat / difficulty or pain swallowing eyes / change in vision / blurry vision / double vision / eye pain
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[DOCX File]Review of Systems
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Symptoms of seasonal allergies, post nasal drip, GERD, aspirin sensitivity, all which can worsen underlying asthma. PMH: Asthma—4 ED visits in the last 3 months; asthma as a child with multiple hospital admissions . What additional PMH do you want to know? Last hospital admission (any in …
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[DOC File]ALLERGIC RHINITIS
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Current Allergy Symptoms or Problems: (circle all that apply) runny/stuffy nose post-nasal drip sneezing itching of eyes, ears, nose, throat, or skin sinus pain or …
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[DOC File]storage.googleapis.com
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Day Post nasal drip (clear/ white/ other) Circle One Night, nights per week? ___ Sore throat With exercise or laughter. Ears/Allergic, none, other: Shortness of breath Popping or congestion Chest tightness Itching Chest symptoms per week, ___ days . Eyes, none, other: Stomach, none, other:
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[DOCX File]Sites@Duke | sites.duke.edu
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If “Yes,” which symptoms? ☐ Sneezing fits ☐ Itchy eyes ☐ Itchy nose ☐ Scratchy throat ... ☐teeth abnormalities ☐difficulty swallowing ☐post nasal drip ☐hoarseness ☐mouth breathing. Neurologic: ☐fainting ☐frequent headaches ☐seizures ☐numbness ☐weakness ☐migraines ☐restless legs.
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_____ How long the symptoms last? _____ What do you feel? _____ Do you get wheezing when you get the air in or out? ... Nasal Congestion/Stuffy Nose: How long do you have it? _____ Is it year round or seasonal? _____ is it daily or on/off? _____ How long it last when you have it? ... Post Nasal Drip or Clearing the throat: How long do you have ...
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Postnasal Drip: Symptoms, Signs, Causes & Treatment
Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or …
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[DOC File]Edward McLaughlin
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Nasal and Eye Symptoms: Check the following if they apply to you: ( NONE ( Nasal blockage ( Sneezing ( Post nasal drip ( Itchy nose ( Itchy eyes ( Headache ( Ear problems ( Other: When are you symptomatic: ( Winter ( Spring ( Summer ( Fall. Medications taken and their effects: Suspected or known causes of these symptoms:
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[DOC File]Allergies & Hay Fever
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Allergic symptoms include: nasal stuffiness; clear, watery nasal discharge; itchy, watery eyes; post-nasal drip, often with morning sore throats; hoarse voice; sinus headaches; cough; fatigue; and wheezing. Allergy patients may have any or all of these symptoms. Not all patients with allergy-like symptoms have true allergic rhinitis.
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[DOCX File]PatientPop
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REVIEW OF SYMPTOMS. GENERAL Weight gain or loss of_____ lbs fever fatigue sleep problem . EYE decreased vision R L double vision eye pain _____ ENT sinus post nasal drip swallowing problems hearing loss ringing in ears dizziness TMJ problem _____
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Symptoms of post nasal drip