Chest pain
Onset prior to evaluation
Onset while:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as: .

The pain is relieved with
noYES <-- exertional pain
noYES <-- pleuritic pain

Associated Symptoms:
noYES <-- nausea/vomiting
noYES <-- diaphoresis
noYES <-- shortness of breath

Pertinent PMH
noYES <-- Coronary Disease
noYES <-- Cerebrovascular disease
noYES <-- Diabetes Mellitus
noYES <-- Peptic Ulcer or GERD
noYES <-- Chest injury or overuse

Pertinent Medications:
noYES <-- Aspirin was taken today
noYES <-- Nitroglycerin

Pitfalls:
noYES <-- unilateral leg swelling
noYES <-- recent prolonged travel, recent trauma, hypercoagulable state, hormonal therapy

Cardiovascular risks are reviewed as follows:
Family history of Premature CAD or CVA (age less than 55):
Tobacco use:
Hyperlipidemia:
Hypertension:
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reference: contributed by Dr. Scott Moses, creator/author of the FP Notebook Site Family Practice Notebook

Result - Copy and paste this output: