Gastrointestinal History |
Yes / No |
Do you have gnawing pain / burning in the stomach? |
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Between meals? |
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Middle of the night? |
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What types of food do you avoid? |
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Have you ever vomited up blood? |
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Any recent change in bowel habits? |
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Frequency of loose bowel movements? |
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Problems with constipation? |
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Ever have black tarry bowel movements? |
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Excessive gas in your stomach? |
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Ever had bright red bleeding from the rectum? |
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Do you have pain with bowel movements? |
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©1999, Herbert A. Yates, D.O. and Neal R. Chamberlain, Ph.D.. All rights reserved.