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Medical history
Nais po ng aming mga doktor na matugunan ng matuwid at makabuluhan.ang inyong katanungan sa kalusugan. And pagsagot sa mga katanungan sa ibaba ay lubos na makakatulong sa pag-unawa ng inyong karamdaman. Asahan po ninyo na kayo lamang at mga doktor dito ang makakabasa ng nilalaman.
Age:
*
Gender:
*
Male
Female
Weight:
*
50 lbs (23 kilos)
55 lbs (25 kilos)
60 lbs (27 kilos)
65 lbs (30 kilos)
70 lbs (32 kilos)
75 lbs (34 kilos)
80 lbs (36 kilos)
85 lbs (39 kilos)
90 lbs (41 kilos)
95 lbs (43 kilos)
100 lbs (45 kilos)
105 lbs (48 kilos)
110 lbs (50 kilos)
115 lbs (52 kilos)
120 lbs (54 kilos)
125 lbs (57 kilos)
130 lbs (59 kilos)
135 lbs (61 kilos)
140 lbs (63 kilos)
145 lbs (66 kilos)
150 lbs (68 kilos)
155 lbs (70 kilos)
160 lbs (72 kilos)
165 lbs (75 kilos)
170 lbs (77 kilos)
175 lbs (79 kilos)
180 lbs (81 kilos)
185 lbs (84 kilos)
190 lbs (86 kilos)
195 lbs (88 kilos)
200 lbs (90 kilos)
205 lbs (93 kilos)
210 lbs (95 kilos)
215 lbs (97 kilos)
220 lbs (99 kilos)
225 lbs (102 kilos)
230 lbs (104 kilos)
235 lbs (106 kilos)
240 lbs (108 kilos)
245 lbs (111 kilos)
250 lbs (113 kilos)
255 lbs (115 kilos)
260 lbs (117 kilos)
265 lbs (120 kilos)
270 lbs (122 kilos)
275 lbs (124 kilos)
280 lbs (126 kilos)
285 lbs (129 kilos)
290 lbs (131 kilos)
295 lbs (133 kilos)
300 lbs (135 kilos)
Height:
*
3 feet and below
3 feet 1 in
3 feet 2 in
3 feet 3 in
3 feet 4 in
3 feet 5 in
3 feet 6 in
3 feet 7 in
3 feet 8 in
3 feet 9 in
3 feet 10 in
3 feet 11 in
4 feet
4 feet 1 in
4 feet 2 in
4 feet 3 in
4 feet 4 in
4 feet 5 in
4 feet 6 in
4 feet 7 in
4 feet 8 in
4 feet 9 in
4 feet 10 in
4 feet 11 in
5 feet
5 feet 1 in
5 feet 2 in
5 feet 3 in
5 feet 4 in
5 feet 5 in
5 feet 6 in
5 feet 7 in
5 feet 8 in
5 feet 9 in
5 feet 10 in
5 feet 11 in
6 feet
6 feet 1 in
6 feet 2 in
6 feet 3 in
6 feet 4 in
6 feet 5 in
6 feet 6 in
6 feet 7 in
6 feet 8 in
6 feet 9 in
6 feet 10 in
6 feet 11 in
7 feet
Family History: Mayroon ka bang kapamilya o kamag-anak na mayroong alin man sa mga sumusunod?
Astma (Hika)
Cancer:
Diabetes
Heart Disease
High blood pressure (Altapresyon)
Hypercholesterolemia
Kidney problems (Sakit sa bato)
Liver problems (Sakit sa atay)
Lung problems (Sakit sa baga)
Stroke
Tuberculosis
Thyroid problems
Others: (Isulat ang ibang sakit na wala sa itaas):
Allergy:
Do you smoke?
(Naninigarilyo ka ba?)
*
Please choose
Do smoke (Oo)
Occasionally smoke (Minsan)
Don't smoke (Hindi naninigarilyo)
Do you drink?
(Umiinom ka ba?)
*
Please choose
Do drink (Oo)
Occasionally drink (Minsan)
Don't drink (Hindi umiinom)
Isulat mga gamot na iniinum sa kasalukuyan:
For better answers from your doctors, we recommend you to answer the following questions honestly and accurately. Rest assured that only you and your doctors will see its contents.
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