Can you provide a concise, paragraph‑style, fill‑in‑the‑blank HPI template (using brackets for blanks) for male and female emergency department patients with common chief complaints, including onset, provoking and palliating factors, quality, radiation, severity, timing, associated symptoms, pertinent past medical history, medications, allergies, surgical history, recent hospitalizations, social history, family history, and for females also gynecologic/obstetric history?

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Emergency Department HPI Templates

Male Patient – Common Chief Complaints

Chest Pain/Discomfort: [Age]-year-old male presenting with [substernal/left-sided/right-sided] [pressure/tightness/heaviness/squeezing/burning/sharp/stabbing] chest [pain/discomfort] that began [minutes/hours/days] ago with [sudden/gradual] onset, provoked by [exertion/emotional stress/rest/deep inspiration/position change/none], [partially/completely/not] relieved by [rest/nitroglycerin/antacids/position change/none], described as [constant/intermittent/waxing-waning], radiating to [left arm/right arm/both arms/jaw/neck/back/epigastrium/none], rated [1-10]/10 in severity, associated with [dyspnea/diaphoresis/nausea/vomiting/lightheadedness/palpitations/syncope/none] 1. Past medical history significant for [hypertension/hyperlipidemia/diabetes mellitus/prior MI/prior PCI/prior CABG/CAD/smoking/family history of premature CAD/none] 1. Current medications include [aspirin/beta-blocker/statin/ACE inhibitor/antiplatelet/none] 1. Allergies: [NKDA/specific drug allergies]. Prior surgical history includes [CABG/PCI/other cardiac procedures/none] 1. Recent hospitalizations for [cardiac events/none] within [timeframe]. Social history: tobacco [current/former/never] [pack-years], alcohol [drinks/day or week/none], cocaine use [recent/remote/never], methamphetamine use [recent/remote/never], IV drug use [active/former/never], ambulates [independently/with assistance/wheelchair-bound], ADLs [independent/requires assistance], employed as [occupation/unemployed/retired] 1. Family history of [premature CAD/sudden cardiac death/none] 1.

Shortness of Breath/Dyspnea: [Age]-year-old male presenting with [acute/subacute/chronic worsening] dyspnea beginning [minutes/hours/days] ago with [sudden/gradual] onset, provoked by [exertion/lying flat/none], [partially/not] relieved by [sitting upright/rest/bronchodilators], described as [constant/intermittent], rated [1-10]/10 in severity, associated with [chest pain/orthopnea/paroxysmal nocturnal dyspnea/lower extremity edema/cough/wheezing/fever/diaphoresis/none] 1. Past medical history significant for [CHF/COPD/asthma/CAD/hypertension/diabetes/prior PE/DVT/none] 1. Current medications include [diuretics/beta-blockers/ACE inhibitors/inhalers/anticoagulation/none] 1. Allergies: [NKDA/specific drug allergies]. Prior surgical history includes [cardiac procedures/thoracic surgery/none]. Recent hospitalizations for [CHF exacerbation/respiratory issues/none] within [timeframe] 1. Social history: tobacco [current/former/never] [pack-years], alcohol [drinks/day or week/none], cocaine [recent/remote/never], methamphetamine [recent/remote/never], IV drug use [active/former/never], ambulates [independently/with assistance/wheelchair-bound], ADLs [independent/requires assistance], employed as [occupation/unemployed/retired] 1. Family history of [cardiac disease/pulmonary disease/none] 1.

Abdominal Pain: [Age]-year-old male presenting with [epigastric/right upper quadrant/left upper quadrant/periumbilical/right lower quadrant/left lower quadrant/suprapubic/diffuse] abdominal pain beginning [minutes/hours/days] ago with [sudden/gradual] onset, provoked by [eating/movement/none], [partially/not] relieved by [position change/antacids/bowel movement/none], described as [sharp/dull/cramping/burning/constant/colicky], radiating to [back/groin/shoulder/none], rated [1-10]/10 in severity, associated with [nausea/vomiting/diarrhea/constipation/fever/hematochezia/melena/dysuria/hematuria/none] 1. Past medical history significant for [peptic ulcer disease/GERD/diverticulitis/prior abdominal surgery/pancreatitis/cholecystitis/IBD/none]. Current medications include [PPIs/NSAIDs/anticoagulation/none]. Allergies: [NKDA/specific drug allergies]. Prior surgical history includes [appendectomy/cholecystectomy/hernia repair/bowel resection/none]. Recent hospitalizations for [GI issues/none] within [timeframe]. Social history: tobacco [current/former/never] [pack-years], alcohol [drinks/day or week/none], cocaine [recent/remote/never], methamphetamine [recent/remote/never], IV drug use [active/former/never], ambulates [independently/with assistance], ADLs [independent/requires assistance], employed as [occupation/unemployed/retired] 1. Family history of [GI malignancy/IBD/none].

Female Patient – Common Chief Complaints

Chest Pain/Discomfort: [Age]-year-old female presenting with [substernal/left-sided/right-sided] [pressure/tightness/heaviness/squeezing/burning/sharp/stabbing] chest [pain/discomfort] that began [minutes/hours/days] ago with [sudden/gradual] onset, provoked by [exertion/emotional stress/rest/deep inspiration/position change/none], [partially/completely/not] relieved by [rest/nitroglycerin/antacids/position change/none], described as [constant/intermittent/waxing-waning], radiating to [left arm/right arm/both arms/jaw/neck/back/epigastrium/none], rated [1-10]/10 in severity, associated with [dyspnea/diaphoresis/nausea/vomiting/lightheadedness/palpitations/syncope/fatigue/jaw pain/back pain/none] 1. Past medical history significant for [hypertension/hyperlipidemia/diabetes mellitus/prior MI/prior PCI/CAD/cerebrovascular disease/peripheral artery disease/smoking/family history of premature CAD/none] 1. Current medications include [aspirin/beta-blocker/statin/ACE inhibitor/antiplatelet/oral contraceptives/hormone replacement therapy/none] 1. Allergies: [NKDA/specific drug allergies]. Prior surgical history includes [CABG/PCI/other cardiac procedures/none] 1. Recent hospitalizations for [cardiac events/none] within [timeframe]. Gynecologic history: [premenopausal/postmenopausal], last menstrual period [date/N/A], gravida [number], para [number], currently [pregnant/not pregnant], pregnancy complications [preeclampsia/gestational diabetes/peripartum cardiomyopathy/none] 2. Social history: tobacco [current/former/never] [pack-years], alcohol [drinks/day or week/none], cocaine use [recent/remote/never], methamphetamine use [recent/remote/never], IV drug use [active/former/never], ambulates [independently/with assistance/wheelchair-bound], ADLs [independent/requires assistance], employed as [occupation/unemployed/retired] 1. Family history of [premature CAD/sudden cardiac death/none] 1.

Shortness of Breath/Dyspnea: [Age]-year-old female presenting with [acute/subacute/chronic worsening] dyspnea beginning [minutes/hours/days] ago with [sudden/gradual] onset, provoked by [exertion/lying flat/none], [partially/not] relieved by [sitting upright/rest/bronchodilators], described as [constant/intermittent], rated [1-10]/10 in severity, associated with [chest pain/orthopnea/paroxysmal nocturnal dyspnea/lower extremity edema/cough/wheezing/fever/diaphoresis/palpitations/none] 1. Past medical history significant for [CHF/COPD/asthma/CAD/hypertension/diabetes/prior PE/DVT/pregnancy-related complications/none] 1, 2. Current medications include [diuretics/beta-blockers/ACE inhibitors/inhalers/anticoagulation/oral contraceptives/none] 1. Allergies: [NKDA/specific drug allergies]. Prior surgical history includes [cardiac procedures/thoracic surgery/cesarean section/none]. Recent hospitalizations for [CHF exacerbation/respiratory issues/pregnancy complications/none] within [timeframe] 1. Gynecologic history: [premenopausal/postmenopausal], last menstrual period [date/N/A], gravida [number], para [number], currently [pregnant at ___ weeks/not pregnant], pregnancy complications [preeclampsia/gestational diabetes/peripartum cardiomyopathy/none] 2. Social history: tobacco [current/former/never] [pack-years], alcohol [drinks/day or week/none], cocaine [recent/remote/never], methamphetamine [recent/remote/never], IV drug use [active/former/never], ambulates [independently/with assistance/wheelchair-bound], ADLs [independent/requires assistance], employed as [occupation/unemployed/retired] 1. Family history of [cardiac disease/pulmonary disease/none] 1.

Abdominal Pain: [Age]-year-old female presenting with [epigastric/right upper quadrant/left upper quadrant/periumbilical/right lower quadrant/left lower quadrant/suprapubic/diffuse] abdominal pain beginning [minutes/hours/days] ago with [sudden/gradual] onset, provoked by [eating/movement/menses/none], [partially/not] relieved by [position change/antacids/bowel movement/none], described as [sharp/dull/cramping/burning/constant/colicky], radiating to [back/groin/shoulder/none], rated [1-10]/10 in severity, associated with [nausea/vomiting/diarrhea/constipation/fever/vaginal bleeding/vaginal discharge/dysuria/hematuria/none] 1. Past medical history significant for [peptic ulcer disease/GERD/diverticulitis/prior abdominal surgery/pancreatitis/cholecystitis/IBD/endometriosis/ovarian cysts/PID/none]. Current medications include [PPIs/NSAIDs/anticoagulation/oral contraceptives/none]. Allergies: [NKDA/specific drug allergies]. Prior surgical history includes [appendectomy/cholecystectomy/hernia repair/bowel resection/cesarean section/hysterectomy/oophorectomy/none]. Recent hospitalizations for [GI issues/gynecologic issues/none] within [timeframe]. Gynecologic history: [premenopausal/postmenopausal], last menstrual period [date/N/A], gravida [number], para [number], currently [pregnant at ___ weeks/not pregnant], last pregnancy [date], contraception [type/none], sexually active [yes/no], possibility of pregnancy [yes/no/N/A] 2. Social history: tobacco [current/former/never] [pack-years], alcohol [drinks/day or week/none], cocaine [recent/remote/never], methamphetamine [recent/remote/never], IV drug use [active/former/never], ambulates [independently/with assistance], ADLs [independent/requires assistance], employed as [occupation/unemployed/retired] 1. Family history of [GI malignancy/IBD/gynecologic malignancy/none].

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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