F Frequency (How frequent do u have to pass urine?) I Incontinence (Do u have trouble holding Ux until u get to BR?

) N Nocturia ( do u have 2 wake up @ Night to go to BR?) I Incomplete emptying (do u feel fullness even after Ux) S Stream (How is ur flow of urine? is it cont. or is there any dribbling after Ux?) Strain (Do u have to strain during Ux) Stone (have u passed stones in the past?) H Hematuria (did u notice any blood) Hesitancy (do u have 2 wait b4 starting Ux) C COLOR U Urgency (do u have 2 rush to BR to Ux?) P Pyuria (was there any pus in ur Ux?) Pain (Burning)

S Safety inquiry (Do you feel safe at home?), Sex ever forced? A Alcohol abuse (does your husband abuse alcohol?) Addict (does husband use recreational drugs) F Friends/Family who are aware (Dose any1 f ur friend/Fam know of this) Fractures (Abuse ever resulted in fractures?) E Emergency plan (u have emergency plan?), Ever tried to leave/divorce?Why not? G Guns at home (are there any weapons @ home?) A Afraid of husband , Attacked Children?Attacked u with Guns? R Relationships with husband (how is ur relationship with husband? do you feel Threatened when he is around?, For how long? D Depression (lost wt/appetite/sleep) S Suicidal (idea/plan/attempt) (ever felt like ending it all up?)

S - leep disturbance - Do you have any changes in sleeping habits? I - nterest reduced - Do you have hobbys? - Are you enjoying them as much you used to ? G - uilt sensation and worthilessness - have you ever felt guilty? E - nergy loss and fatigue - Do you feel fatigued? - if Y - is Fatigue same during the day? M Mood do you feel easily agitated or angry C - oncentration problems - any concentration problems? A - ppetite problem - Did you notice any appetite change? weight?

P - sychomotor agitation or retardation - do you feel agitated? S - uicidility - have you recently thought about harming yourself or others? - have you ever tried to harm yourself or others? - If pt says Y - do you have plan? do you have gun at home? if fatigue is CC - also ask about Hypothyrodism and Obst.sleep apnea questions.

P Pain D Discharge F FB I Imbalance / Infection N Noise R Ringing S Spinning T Trauma / Tinnitus

Begin with :Is there anything in the daily living you can't do by yourself? D - ressing: Do you have problem wearing clothes? E - ating: Do you have problem eating by yourself? (Can ask alone with F) A - mbulation: Do you have problem getting in and out of bed? T - oileting: Do you have problem using toliet? H - ygiene: Do you have problem bathing? S - hopping: Do you have problem shopping? H - ousekeeping: Do you have problem keeping your house clean? A - ccounting: Do you have problems managing money? F - ood preparation: Do you have problem preparing food? T - ransportation do you have any problem driving a car or taking a bus? Additional Qs: - What are those Things that are difficult to remember; What are those things that you are forgetting? - Have you ever felt lightheaded? - Have you ever passed out? - Have you had any recent falls? - Do you have any speech difficulties?

- Any Heart problems? - Do you have family or friends who can take care of you? - any gait problems? - any seizures or shaking? - any weakness/numbness?