History of the present illness

Not to be confused with Past medical history.

Following the chief complaint in medical history taking, a history of the present illness (abbreviated HPI)[1] (termed history of presenting complaint (HPC) in the UK) refers to a detailed interview prompted by the chief complaint or presenting symptom (for example, pain).

Questions to include

Different sources include different questions to be asked while conducting an HPI.

Several acronyms have been developed to categorize the appropriate questions to include.

The Centers for Medicare and Medicaid Services has published criteria for what constitutes a reimbursable HPI. A "brief HPI" constitutes one to three of these elements. An "extended HPI" includes four or more of these elements.[2][3]

CMS "OPQRST"[4][5]
or "PQRST"[6][7]
("S" = Symptoms)
location "R": Region and Radiation "L": Location "L": Location "L:" Location "L:" Location
quality "Q": Quality of the pain "C": Character "Q": Quality "C:" Characteristics "C": Character
"R": Radiation "R": Radiation see above "R": Radiation
severity "S": Severity "S": Severity "I": Intensity see above "S": Severity
duration "O": Onset "T": Time frame "O": Onset "O:" Onset
"H:" History
"D:" Duration
timing "T": Time see above see above see above "O": Onset
modifying factors "P": Provocation or Palliation "E": Exacerbation "A": Aggravating factors "A:" Aggravating factors "E:" Exacerbation
"A": Alleviation "A": Alleviating factors "R:" Remitting factors "R:" Remitting factors
associated signs & symptoms "A": associated symptoms "A": Associated symptoms see above "A": Associated symptoms

Also usable is SOCRATES. For chronic pain, the Stanford Five may be assessed to understand the pain experience from the patient's primary belief system.

Medicare definitions

CMS required history elements[11]
Type of history CC HPI ROS Past, family, and/or social
Problem focused Required Brief N/A N/A
Expanded problem focused Required Brief Problem pertinent N/A
Detailed Required Extended Extended Pertinent
Comprehensive Required Extended Complete Complete

See also


External links

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