Gastrointestinal History 

Yes / No

Do you have gnawing pain / burning in the stomach?
N
Between meals?
N/A
Middle of the night?
N/A.
What types of food do you avoid?
None
Have you ever vomited up blood?
N
Any recent change in bowel habits?
N
Frequency of loose bowel movements?
None; Last summer after trip from Cancun I had 10-15 loose stools per day.
Problems with constipation?
N
Ever have black tarry bowel movements?
N
Excessive gas in your stomach?
N
Ever had bright red bleeding from the rectum?
Y: hemorrhoids after giving birth to 12 year old child.
Do you have pain with bowel movements?
N

Continue

©1999,  Herbert A. Yates, D.O. and Neal R. Chamberlain, Ph.D.. All rights reserved.