Can you provide a sample HPI structured template in sentence form?

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Sample HPI Structured Template in Sentence Form

A comprehensive History of Present Illness should be documented as a narrative that integrates patient and informant reports, characterizes symptom onset and temporal progression, explores contextual relationships, and systematically assesses impact on daily function across all relevant domains. 1

Core Narrative Structure

The HPI begins with the patient's chief concern stated in their own words, followed by a chronological account of symptom development. 2 For example:

"[Patient name] is a [age]-year-old [gender] who presents with [chief complaint]. The patient reports that symptoms began [timeframe] when [describe initial presentation]. Initially, the symptoms were characterized by [quality, severity, location]. Over [time period], the symptoms have [progressed/remained stable/improved], now occurring [frequency] and lasting [duration]. The patient notes that symptoms are triggered by [precipitating factors] and relieved by [alleviating factors]. Associated symptoms include [list relevant positives]. The patient denies [pertinent negatives]." 1, 3

Temporal Progression and Context

Document the sequential order of symptom onset, frequency, tempo, and nature of change over time, exploring plausible relationships between events and presenting symptoms. 1 For instance:

"The condition has evolved from [initial presentation] to [current state] over [timeframe]. Notable changes occurred following [specific events or triggers]. The patient describes the pattern as [constant/intermittent/progressive], with exacerbations related to [contextual features]." 2

Functional Impact Assessment

Evaluate and document how symptoms affect activities of daily living (bathing, dressing, eating, toileting, transferring, continence), instrumental activities of daily living (managing finances, medications, transportation, shopping, meal preparation, housework), interpersonal relationships, work performance, and community engagement. 2 Example phrasing:

"These symptoms have significantly impacted the patient's ability to [specific ADL/IADL limitations]. The patient reports difficulty with [specific activities], requiring assistance from [care partner/family] for [tasks]. Work performance has been affected by [specific limitations], and social activities have [increased/decreased/changed]." 1, 2

Domain-Specific Symptom Assessment

For Cardiac Presentations

"The patient describes chest discomfort as [quality: pressure/squeezing/heaviness/sharp/burning], located [retrosternal/left-sided/radiating to left arm or jaw], lasting [duration], triggered by [exertion/rest/emotion/cold weather/meals], and relieved by [rest/nitroglycerin/position change] within [timeframe]. Associated symptoms include [diaphoresis/dyspnea/nausea/palpitations]. The patient denies [pertinent negatives]." 1

For Cognitive or Behavioral Presentations

"According to both patient and [informant relationship], cognitive changes began [timeframe] and initially manifested as [specific domain: memory/executive function/language/visuospatial]. The informant reports noticing [specific examples of functional decline]. Behavioral changes include [mood alterations/neuropsychiatric symptoms/personality changes]. The patient's insight regarding these changes is [intact/impaired/absent]." 1

For Respiratory Presentations

"The patient reports dyspnea that is [present at rest/on exertion], requiring [specific activity level to trigger: walking distance/stair climbing/dressing]. Orthopnea is [present/absent], with the patient sleeping on [number] pillows. Paroxysmal nocturnal dyspnea [has/has not] occurred, characterized by [description]. Associated symptoms include [cough/wheezing/chest tightness/sputum production]." 1

Informant Corroboration

Always integrate reliable information from an informant regarding changes in cognition, daily function, mood, and sensorimotor function, as informant reports provide added value beyond patient self-report alone. 1 Document as:

"The patient's [relationship], who has [daily/weekly] contact and has known the patient for [duration], corroborates [specific details] but additionally reports [information not volunteered by patient]. The informant notes particular concern about [specific observations]." 2

Risk Factor and Contextual Information

"Relevant risk factors include [cardiovascular risk factors/family history/environmental exposures/occupational hazards]. The patient has a history of [pertinent past medical conditions with year of onset]. Current medications include [list with indication]. Social history is significant for [tobacco/alcohol/substance use quantified]. Recent life events include [stressors/changes/exposures]." 1, 2, 4

Medication and Treatment Response

"Previous treatments for this condition include [specific interventions], which resulted in [response: improvement/no change/worsening]. The patient is currently taking [medications] with [adherence pattern]. Medication-taking behavior reveals [barriers such as cost, side effects, or complexity]." 2

Synthesis Statement

Conclude the HPI with a synthesis that establishes pretest probability and guides subsequent diagnostic reasoning. 3 For example:

"In summary, this [age]-year-old [gender] with [risk factors] presents with [duration] of [symptoms] characterized by [key features], resulting in [functional impact]. The temporal pattern of [progression description] and associated features of [relevant findings] suggest [differential considerations], with particular concern for [high-risk diagnoses requiring exclusion]." 3

Critical Documentation Elements

  • Onset timing: Specify exact dates or timeframes when possible 1, 2
  • Symptom quality: Use patient's own descriptive words in quotes 2
  • Quantification: Include measurable parameters (distance walked, number of pillows, weight change in pounds/kilograms, frequency per day/week) 1
  • Change over time: Document whether symptoms are better, worse, or unchanged since last assessment 1
  • Safety concerns: For psychiatric presentations, explicitly document presence or absence of suicidal/homicidal ideation with specific details 4

Common Pitfalls to Avoid

  • Failing to use structured approaches leads to missed symptoms and incomplete assessments 3, 2
  • Neglecting informant interview results in missing critical collateral information, particularly when patient insight is impaired 1, 2
  • Relying solely on closed-ended questions significantly reduces information obtained 2
  • Omitting environmental and occupational history can miss reversible causes 2
  • Not documenting pertinent negatives undermines diagnostic reasoning 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Conducting a Comprehensive History of Present Illness Interview

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

The Importance of a Comprehensive History of Present Illness in Clinical Practice

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

4
Guideline

Psychiatric Evaluation Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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