Case Submission Form for acute complaints – Hussain Kaisrani

Describe your present complaint (s).

What else goes with it?

What do you think is its cause (dietary errors, overexertion (mental and / or physical), injury, exposure to cold, heat, wetting, etc.)?

What does cause increase or decrease or relief of the complaint? (e.g. motion, sleep, posture, heat, cold, open air, when in room, light, noise, touch, pressure, eating, drinking, etc.)

When does the complaint get worse? (Morning, noon, afternoon, evening, midnight, night, etc.)

What are the things that interfere with your comfort (e.g. light, noise, presence of people, etc.)

Presence of any of the following: irritability, sadness, fear, placidity, restlessness, talkativeness, taciturnity, desire to have someone nearby, desire to be alone, etc.

Anything else?

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kaisrani

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