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The history of present illness (HPI) is also called the primary history. It is a detailed set of questions designed to elaborate on the patient’s chief complaint or presenting symptom. An accurate history is the first step in determining the etiology of the patient’s concern. In fact, frequently, the diagnosis can be made simply on the history and physical examination.
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There are several general questions that are applicable to most symptoms. Many acronyms have been proposed for memorizing the elements of the HPI. The one we include here is the OLD CARTS method:
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Onset
Location
Duration
Characteristics
Aggravating factors
Relieving Factors
Treatments tried
Symptoms associated
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Remember that an accurate history is not only important in determining the diagnosis, but is essential for proper reimbursement. The Centers for Medicare and Medicaid Services has defined criteria for what qualifies as a “reimbursable” HPI. A brief HPI includes one to three of the following, whereas an extended HPI must include four or more elements.
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Timing Onset
Location
Duration
Quality (Characteristics)
Severity (Characteristics)
Context (Onset)
Modifying factors (Aggravating/Relieving factors)
Associated signs and symptoms (Symptoms associated)
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Included in this chapter are many of the acute symptoms most commonly encountered in clinical practice. The questions are designed to elicit a differential diagnosis for each complaint. Of course, not all the elements of the OLD CARTS questions can be applied to all symptoms; for example, insomnia has no location. But wherever possible, we attempted to incorporate as many questions as were appropriate to each symptom.
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