Where is the pain?
EpigastricLeft Upper Quadrant (LUQ)Right Upper Quadrant (RUQ)Left Lower Quadrant (LLQ)Right Lower Quadrant (RLQ)UmbilicalEverywhere
Did the pain come on suddenly or slowly?
SuddenSlow
Is the pain constant or intermittent?
ConstantIntermittent
Does the pain go anywhere else?
NoFlankChestShoulder tipBackOther sites
Did you vomit continuously in the past 24 hours?
NauseousIntermittentFood/fluidBright red bloodDark red bloodDark green bileOtherNo
Did you pass any blood in your stool?
NoBright redTar-like/coffee groundMixed bright & dark redRedcurrant/jelly-like
Have you noticed any changes in your bowel movement?
NoLoose stoolConstipationDiarrhoeaOther
Did you suffer from any physical injury recently?
YesNo
Did you notice any lumps or bumps anywhere on your body?
YesNo
Did you or anyone notice that your skin/eyes turned yellow?
NoEyesSkin
Have you lost any weight unintentionally in the past 6 months?
YesNo
Are you pregnant?
NoPossibly<20 weeks>20 weeks