Ros Questions

Front 1

ROS
Head and Neck

Back 1

-Do you have any problems with HA?
-If so, any associated nausea, vomiting, or vision changes?
-Do you have any problems with pain or stiffness in your neck?

Front 2

ROS
Eyes

Back 2

-Have you had any recent changes in your vision?
-Have you ever worn glasses or contacts (now or in the past)?
-Do you have any problems with blurred vision, flashing lights or halos around lights?
-Do you have any problems with eye discharge or excessive tearing?

Front 3

ROS
Ears

Back 3

-Have you ever had any trouble hearing; if so, was it one or both ears (gradual or sudden)?
-Have you had any earaches or pain in or around your ears recently?
-Do you have any ringing or buzzing that lasts for an hour or more?

Front 4

ROS
Nose

Back 4

-Do you have problems with runny nose, stuffy nose or allergies (hay fever)?
-Do you have any sinus or facial pain?
-Have you ever had any nasal injuries or nose bleeds?

Front 5

ROS
Mouth and Throat

Back 5

-Do you have any sores in your mouth, tongue or on your gums?
-Do you have bleeding gums, tooth pain or any loose teeth?
-Do you wear dentures or have partials?
-Have you notices frequent sore throats, hoarseness, or changes in your voice?

Front 6

ROS
Neck (Pulmonary)

Back 6

-Any swelling or tenderness in your neck?

Front 7

ROS
Pulmonary

Back 7

-Do you ever wheeze?
-Do you ever have difficulty breathing or feel SOB? (if yes, is onset at rest or exertion)
-Do you have presently have a cough? (if yes, is there sputum production? what color and consistency?)
-Have you ever coughed up blood?
-Do you have trouble breathing when lying flat in bed?
-Do you have any shortness of breath at night?
-Have you noticed any weight loss, fever, or night sweats?
-Do you smoke?

Front 8

ROS
Heart

Back 8

-Do you have any chest pain or chest discomfort?
-Have you ever coughed up blood?
-Have you had any fainting spells?
-Do you have any leg swelling?
-Have you felt any palpatations or skipped heartbeats?
-Do you have any SOB?
-Do you have a cough?
-How many pillows do you sue when sleeping (or lying down)?
-Do you have trouble with fatigue?

Front 9

ROS
Peripheral Vascular

Back 9

-Do you have any cramping, aching, fatigue, numbness, pain of buttock, thigh, calf or foot?
-Do you have abd pain after meals?
-For males: Do you suffer from erectile dysfunction?
-Have you had any cramping in your legs when walking?
-Do you have any sores or ulcers that won't heal?

Front 10

ROS
Skin, Hair, Nails

Back 10

-Have you noticed any changes in your skin?
-Have you noticed any changes in your hair?
-Have you noticed any changes in your nails?
-Have you had any rashes?
-Have you had any sores?
-Have you had any lumps?
-Have you had any itching?