Essential Components of the History of Present Illness (HPI)

Core Elements of the HPI

The American College of Physicians recommends documenting the onset and chronology of symptoms, including when they began, their progression over time, and any patterns or changes in intensity 1
The American Heart Association suggests identifying the location of symptoms and if they radiate or move 2
The Infectious Diseases Society of America recommends recording the patient's description of how symptoms feel, such as sharp, dull, or burning 1
The American College of Cardiology advises assessing the severity of symptoms using scales or by asking how symptoms impact daily activities 2
The Centers for Disease Control and Prevention recommends documenting the duration of symptoms and how long they last when they occur 1
The National Institutes of Health suggests noting activities or situations when symptoms occur or worsen 1
The American Academy of Family Physicians recommends identifying what makes symptoms better or worse, including medications or interventions 1
The American College of Emergency Physicians advises recording other symptoms that occur simultaneously 2

The American Medical Association recommends documenting all prescription drugs, over-the-counter medications, supplements, and herbal remedies 1
The Centers for Disease Control and Prevention advises asking about hypersensitivity reactions to medications 1
The National Institutes of Health recommends inquiring about prior treatments for the current condition and their effectiveness 1

The American Heart Association suggests documenting history of conditions like heart failure, renal insufficiency, diabetes, or lung disease 2
The American Diabetes Association recommends asking about past hospitalizations related to the current complaint 6
The Infectious Diseases Society of America advises recording relevant surgical procedures 1
The Centers for Disease Control and Prevention recommends documenting vaccination history, particularly for influenza and pneumococcal vaccines 2

The American College of Physicians recommends asking about tobacco, alcohol, and recreational drug use 1
The National Institute for Occupational Safety and Health suggests inquiring about work-related exposures that may contribute to symptoms 7
The American Lung Association advises assessing living conditions that might impact health 7
The American Cancer Society recommends identifying support systems and resources available to the patient 5

The American Heart Association suggests asking about family history of conditions related to the presenting complaint 6
The American College of Medical Genetics recommends documenting the age at which family members developed relevant conditions 1

The American Geriatrics Society recommends paying particular attention to functional status, cognitive function, and fall risk in elderly patients 5
The American Diabetes Association advises focusing on changes from baseline and disease-specific symptoms in patients with chronic conditions 2
The National Institute on Deafness and Other Communication Disorders recommends using appropriate communication aids or interpreters as needed for patients with communication barriers 5

The American Medical Association recommends documenting pertinent negatives, including important symptoms that are absent 1
The Joint Commission advises using clear language that can be understood by other providers 1