1. Personal Information
name
age and gender
nationality and the country of grown-up( This is for the
environment of growth)
occupation
length and weight
eye color
2. Medical History
family history
past history
pesent history
3. Chief Complaints ( Please describe in detail )
4. Other Symptoms Relating to Your Body or Mental Status
5. Medical Signs
pulsatory motion(number, strength and others as you can feel)
color of the face(not the skin color but the impression)
digestion function(good, gas, feeling heavy, stuffy, pains and
other things as you can feel)
urination(frequency per day, color, and others that you are feeling)
feces( frequency, color, hardness, and others)
foods( especially favorites, alergic foods and other special things)
sweat( much, average, little, and the area of frequent sweating
for ex. middle of breast or palm or face or head, etc)
menstration( regularity, period, quantity, pain and pain area and
othe things)
conea color( white, grey, yellowish, bloody)
skin( thin, thick)
tongue( white coated, yellowish coated, stained with purple,
reddish or pinky, dry or wetty with area for ex. apex or
middle or root of tongue)
If you send the photo of tongue by e-mail or mobile phone(
010-2987-2674, korea), that will be best!
abdomen( the area of pain or hardness with finger press)
finger nail( long or short, round or triangle, frontal or sagittal
section, color where are dark or white for ex. root or
end?)
6. Other things you want to talk about.
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