Best Gynecology Endoscopic Surgeon in Bhubaneswar - Dermatologist in Bhubaneswar

1. DERMATOLOGY QUESTIONAIRE ASHU SKIN CARE: Name: Address: Date: Diagnosis: Score: The aim of this questionnaire is to measure how much your skin problem has affected your life. Please check one box for each question. Tell me about the issues you’ve been experiencing ? (Histroy of Present Illness) Where is the skin lesion?” “When did you first notice the skin lesion?” WHICH AREA • FACE• BODY • HAND• LEGS • OTHER 1.ONSET OF SKIN LESION ; •SUDDEN •GRADUAL 2.DURATION OF SKIN LESION : •DAYS •MONTHS 3.FIRST EPISODE (DATE) 4.EVOLUTION OF INDIVIDUAL LESIONS 5.EXACERBATING FACTORS : • SUNLIGHT• HEAT • COLD• PERIOD (F) 6.DISTRIBUTION ; SPREAD IN Are There any other symptômes that seem associated with the rash?” • ITCHING• PAIN• NUMBNESS• FEVER • JOINT PAIN• HAIR LOSS• BLEEDING • BLISTERING• DISCHARGE• WT. LOSS •CHANGES IN SKIN COLOR •HEADACHE • NASAL CONGESTION •THROAT PAIN •CHANGES IN HAIR •REDUCED APETITE Not relevant CVS:- CHEST PAIN, PALPITATION PS:- COUGH. EXPOTRATION, How does the skin lésion feel when you touch it?” “How many of the skin lesions are there & Shape? •ELEVATED, •NORMAL, •BLISTERS •ONE, •A FEW, •MANY •ROUND, •IRREGULAR, •NO DEFINITE SHAPE • FOOD - NON VEG - EGG, FISH. MUTTON. Not relevant HISTORY OF EXPOSURES

2. HISTORY OF ALLERGIES DRUGS FOOD SEASONAL •VEG – MUSHROOM, BRINJAL. • PETS & INSECTS. • CONTACT HISTORY: SOAP, ROOM CLEAN • H/O TO ANY MEDICATION DRUGS, IMMUNIZATION Not relevant HISTORY OF PAST ILLNESS •DIABETES. •HYPERTENSION • TUBERCULOSIS •PAST HISTORY OF SKIN DISORDER •GENERAL MEDICAL HISTORY •ALLERGY DESEASES./ TO DRUGS. •ANY OTHER CHRONIC MEDICATION:- WHEN , WHAT MEDICATIONS COMPLIANCE , CONTROLLED Not relevant “Have you tried any treatments for your rash?” “Did they make any difference? •Very much •A lot • A little •Not at alL OINTMENTS TOPICAL STEROIDS ANTIBIOTICS IMMUNO SUPPRESSANTS Not relevant “Have you been in contact with anyone recently who had an infectious disease or skin problems like yours?” YES NO Not relevant Do you have any medical conditions?” “Are you currently seeing a doctor or specialist regularly?” Very much A lot A little Not at all Not relevant OBGYN HISTORY FOR FEMALE PATIENTS PERIODS •REGULARITY•FLOW•PADS PER DAY •CRAMPS•PREGNANCY•AB ORTION Not relevant

3. •ABNORMAL VAGINAL DISCHARGE SOCIAL HISTORY SMOKING :- •DURATION •NO. OF CIGARETTES PER DAY INTERESTED TO QUIT ALCOHOL:- •DURATION•AMOUNT•INTERESTED TO QUIT •FOR DIABETES •FOR HYPERTENSION •FOR HIGH CHOLESTEROL•FOR WEIGHT LOSS •FOR MUSCLE GAIN Not relevant ANY SPECIFIC DIET HISTORY HISTORY OF PREVIOUS HOSPITALISATION COVID Not relevant ANY TRAUMA FAMILY HISTORY DISEASES RUNNING IN FAMILY ANY ALL CONTACTS RECENTLY Not relevant Pelasse check You have answered EVERY question. Tank You.