How do you phrase a negative review of systems in a concise summary sentence?

Standard Documentation of Negative Review of Systems

A negative or normal review of systems should be documented as: "All systems reviewed and negative except as noted in the history of present illness" or "Review of systems: negative for constitutional symptoms, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurological, psychiatric, endocrine, hematologic, and dermatologic complaints." 1

Essential Components of Documentation

Constitutional Symptoms Must Be Explicitly Addressed

• Always document the absence of fever, night sweats, unintentional weight loss, and fatigue as these are critical screening elements for serious pathology 2
• Night sweats specifically should be noted as absent, as their presence indicates potential infectious processes (tuberculosis, HIV), malignancies (lymphomas, hematologic malignancies), or myeloproliferative disorders 2
• The combination of fever, weight loss, and night sweats (B symptoms) significantly increases concern for serious underlying disease 2

Neuropsychiatric Symptoms Require Specific Documentation

• Document the absence of confusion, disorientation, hallucinations, and delusions, as these symptoms distinguish life-threatening medical conditions from primary psychiatric disorders 3
• Visual hallucinations are the strongest indicator of underlying medical causes rather than psychiatric disorders 3
• Up to 46% of patients with psychiatric symptoms have causative or exacerbating medical diseases, making thorough documentation critical 3
• The presence or absence of altered mental status helps differentiate delirium (a medical emergency with doubled mortality if missed) from primary psychosis 3

Organ System-Specific Documentation

Cardiovascular System

• Document absence of chest pain, palpitations, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and edema 1

Respiratory System

• Note absence of dyspnea, cough, wheezing, hemoptysis, and chest pain with breathing 1

Gastrointestinal System

• Record absence of nausea, vomiting, diarrhea, constipation, abdominal pain, and changes in appetite 1

Genitourinary System

• Document absence of dysuria, hematuria, frequency, urgency, and oliguria 1

Neurological System

• Note absence of headache, dizziness, syncope, weakness, numbness, vision changes, and seizures 1

Critical Pitfalls to Avoid

Never Use Vague Language

• Avoid phrases like "ROS negative" without specifying which systems were reviewed 1
• Each organ system should be explicitly mentioned or a comprehensive statement used 1

Do Not Omit High-Risk Symptoms

• Failure to document the absence of constitutional symptoms (fever, weight loss, night sweats) can miss serious pathology including infections and malignancies 2
• Omitting neuropsychiatric symptoms can result in missed delirium, which doubles mortality 3

Distinguish Between "Not Asked" and "Negative"

• If a system was not reviewed, document this explicitly rather than implying it was negative 1
• This distinction is medically and legally important 1

Clinical Context Considerations

Asymptomatic Hypertension Screening

• When evaluating asymptomatic hypertension, the review of systems should specifically address subtle vision changes, mild confusion, dyspnea on exertion, and oliguria as these may indicate end-organ damage not apparent in the chief complaint 1

Sickle Cell Disease

• A comprehensive respiratory and sleep history within the review of systems is essential for identifying patients requiring further evaluation 1
• Document absence of wheezing, increased cough, dyspnea, chest pain, exercise limitation, and syncope 1