HOW TO USE THIS PAGE

• This is a static landing page. Click here to download an editable version. Do this as many times as you need.
• Click here for examples of this template filled out and ready to go for an appointment.

INTENTION

• This document was made by SpiralGuide (IG | twitter) in solidarity with how difficult medical appointments can be when you are managing many conditions and symptoms while chronically ill. May this be a tool that brings some ease to your appointments and makes them more fruitful.
• This is intended to be used as a starting point for describing your Chief Complaint to your doctor during your appointment.

BEFORE YOU BEGIN

• How long is your appointment? Is it a 45 minute appointment to establish care with a new doctor? Is it a 15 minute follow-up or med-check? Knowing this will help you make the most of your time.
• Who is your appointment with? What do they specialize in? This may narrow which Chief Complaint you decide to bring up. If you are not receiving the care you need, sometimes you may need to take your Chief Complaint to a different specialist.
• Each Chief Complaint requires its own History of Present Illness. So if you have three Chief Complaints, you would fill out three of these templates.
• As a general rule, include no more than three Chief Complaints in one appointment—any more than three may reduce how effectively each Chief Complaint can be addressed. Bring up the ones of highest priority first.

TIPS

• Be concise.
• Be specific. During an appointment, “This symptom prevents me from walking more than a few feet at a time, showering more than once a week, leaving the house or preparing meals for myself” is more likely to be noted in your record than “this symptom makes everything difficult”.
• Keep in mind it is technically the doctor’s job to get all of this history from you. Some doctors are excellent history-takers. Some are not. This is an extra layer to ensure that what needs to get communicated to your doctor and recorded to your medical record does.
• If you do not have the capacity to fill out this whole template, concentrate your energy solely on defining your Chief Complaint concisely. If you have multiple Chief Complaints, put them in order of priority. That alone is a very useful tool.

EXAMPLES OF USING THIS

TEMPLATE IN AN APPOINTMENT

• “I have two Chief Complaints today. I also have really bad brain fog, so if you see me referring to this piece of paper (or phone), it’s because I have difficulty with memory but want to make sure I don’t leave anything out.”
• “I brought this concise list about my Chief Complaints. Is it okay if I just read through it? Please stop me if you have any questions or want me to elaborate.”
• “I get overwhelmed with the amount of details I need to cover so I made this list about my Chief Complaints. I’ll be referring to it often. You are welcome to have a copy.” (In this case, bring a copy.)
• “Would you be willing to take a copy of this for my medical record?” (This may be useful when you want things documented precisely for Social Security or Disability claims.)

If you are printing this to give to your doctor for documentation, delete everything from here up.

CHIEF COMPLAINT (CC)

HISTORY OF PRESENT ILLNESS

OTHER CONSIDERATIONS