2. Collecting Demographic Data
Note : Typical client information entered in the
admission sheet : name – ID card – age – DOB –
sex – marital status – occupation and employer ,
etc.
4. Take a look at this form.
What questions should you ask ?
Name Occupation
Date of birth Sex
Reason for
visit
Allergies
( food,
medication,
other )
Current
medications
Substance use
(tobacco,
alcohol, other)
.............../ day
Medical
conditions
Other
5. Questions
Name What is your name ? Can I have your name
please ?
Polite could I have your name please ?
Date of birth What is your date of birth ?
Could I have your DOB ( date of birth ) please ?
When were you born ?
Reason for visit What is wrong ?
What’s the matter ?
Why did you come here today ?
What is bothering you ?
Can I help you ?
6. Questions
Current
medications
Are you taking any medication ?
What medication are you taking ?
Do you take any medication ?
Medical
condition ?
Do you have any medical problems ?
Do you have ....? ( diabetes, high blood
pressure? heart problems ?
Have you ever been diagnosed with ......?
Occupation What do you do ?
What is your occupation ?
What do you do for a living ?
7. Questions
Allergies
-Food :
- medications :
-other
Do you have any allergies to.......? Are you a
allergic to ?
- any food
- any medication ?
- anything ?
Substance use
-Tobacco :
- alcohol
-Other
Do you smoke ? Yes how much per day ?
Do you drink ? Yes how much per day ?
Do you use drugs ?
Other Is there anything else we should know ?
Is there anything else you’d like to tell us ?
8. Useful Expressions
Explaining what are you going to do
• It is time for me to......
• I just want to......
• I would like to.....
• I am going to.....
• I need to.......
interview you
assess your health condition
9. Well, Mr. Pitt I need to collect your
Personal data. I am going to ask you
some questions..
Certainly, Doc..
10. Questions To Collect Demographic
Data elements
Name :
• What is your name ?
• What is your complete name ?
• What is your surename ?
• Can you spell it for me, please .
Age :
• How old are you now?(try to avoid this question)
• What is your DOB ?
11. Address :
• What is your address ?
• Where do you live ?
• Where do you stay ?
Phone :
• Your phone number please .
• What is your phone number ?
• Do you have a mobile phone number ?
Questions To Collect Demographic
Data elements
12. Marital status :
• Are you married ?
Health Insurance :
• Do you have Health Insurance ?
• Are you holding any Health Insurance ?
• I need to make a copy of it, please.
Questions To Collect Demographic
Data elements
13. Occupation :
• What is your occupation ?
• What do you do for a living ?
• Do you have any academic title ?
• What is your title ?
Questions To Collect Demographic
Data elements
14. Next of kin :
• Who is your next of kin ?
Reason for contact :
• What brings you to this hospital ?
• Who sends you to this hospital ?
• What makes you come to this hospital ?
Questions To Collect Demographic
Data elements
16. Current Health and Illness Status
• Useful expressions
– What do you think about your health ?
– Would you tell me about your health condition
recently ?
Common patient response :
– I am usually in healthy condition
– Nothing major, such as usual cold, cough, etc.
– I have to take medicine for my cholesterol
17. Elemination Pattern
• Would you tell me about your .......?
• How many times a day do you do your .........?
• Do you have any problem with your .....?
– Bowel motion
– Waterworks
• Is the stool formed or loose ?
• Is your urine darker ?
• Do you have any pain when urinate ?, etc
19. History of Past Health and Ilness
Past Medical History ( PMH )
• Do you have any past medical history, I should
concerns of ?
PMH : heart disease, asthma, DM, etc.
20. History of Past Health and Ilness
Asking common communicable diseases
• Have you ever had + a kind of disease.....?
Response : Yes, I have or I have not
• How old were you when you got it ?
Response : I was about ......years old
Kinds of diseases : measles, mumps, chicken
pox – rubella, rheumatic fever, diptheria, TB
21. History of Past Health and Ilness
Asking about immunizations
• Have you ever been immunized against + a
kind of disease.....?
• Have you ever got + a kind of disease ...
Immunizations?
– Example : have you ever got polio immunization?
22. History of Past Health and Ilness
Asking about allergies
• Are you allergic to a certain +
food/medication?
• Do you have any history of allergic reaction
against medications ?
Medications : Pain killer, antibiotic, etc
Foods : wheat, poultry products,etc
