Medical Question Worksheet
- EXACT NAME OF THE CONDITION: Is this a lay term or the one used by the phsician? Is the patron sure of the spelling?
- WHAT PART OF THE BODY IS AFFECTED?
- AGE OF THE PATIENT?
- SEX OF THE PATIENT?
- TYPE OF INFORMATION NEEDED:
In-depth medical information?____________
Written in layman's terms?_______________
- SPECIFIC INFORMATION NEEDED:
Signs or symptoms ___________
Prognosis (Likely outcome)___________
Specialists in the field __________
- PURPOSE: What prompts the person to ask? (Is this for a relative? For the patron? For the school?)
- SPECIFICALLY FOR DRUG INFORMATION REQUESTS:
- NAME OF DRUG: Is this a generic name or a trade name? Is the patron sure of the spelling?
- IS IT AN OVER-THE-COUNTER DRUG? (Available without a prescription?)
- WHAT SPECIFIC INFORMATION IS NEEDED: (For example, side effects, reason for prescribing?)
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This page was last updated on August 7, 2003.