Anamnesis for patient of

geriatric

Identity

Name
Gender
Age
Religion
Education
Address
Phone
Occupation
Primary care provider

Number of child
Number of
grandchild
Number of great
grandchild
Date and time of
appointment

Medical History
Principle Complaint
Past Medical History, consist:
Past Surgery History
Past hospitilization History
Another Medical History
Allergy History
Additional Complaint
Onset

Anamnesis of System

Neurological
Head and neck
Breast
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary

Musculosceletal
Skin
Endocrine
Hematology
Female only: Last
menstrual period?
Male only: Erectile
dysfunction?

Anamnesis of Habit

Smoke
Alcohol
Daily of foods
Sport

Anamnesis of Environment

Where do you live?

How situation in the house?
Where do you sleep?
In the room, is there a toilet?

Consuming drugs history

How many drugs you consume?
With the doctors recipe/without?
Dose?

Physicology
Confusion?
Insomnia?
Suspicious?

Prime problem geriatric

history

Falls?
Inkontinensia?
Decubitus?
fracture