history of present illness


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history of present illness

Medical practice A chronologic description of the development of the Pt's present illness, from the 1st sign and/or Sx or from the previous encounter to the present; HPI includes location, quality, severity, duration, timing, context, modifying factors, and associated signs and Sx. See Evaluation and management services.

his·to·ry of pre·sent ill·ness

(HPI) (his'tŏr'ē prez'ĕnt il'nĕs)
A detailed formal statement of available historical data about a patient's presenting complaint.
References in periodicals archive ?
History of present illness; review of systems; and past, family, and/or social history elements are highlighted as appropriate.
After a relatively short history of present illness (HPI) that said my patient had presented with 1 day of headache and chest pain.
After reviewing many charts from several organizations, however, I'm concerned that 3 important elements of documentation are getting short shrift in our increasingly computerized and regulated environment: the history of present illness, the assessment, and the plan.
We have also noticed that some physicians are able to type their history of present illness while maintaining eye contact with the patient, only occasionally looking down at the screen.
History of present illness: Mr M developed symptoms of schizophrenia at age 17.
They peck away at the keyboard, staring at the computer screen--or, even worse, the keyboard itself--while slowly entering a patient's history However, we have also noticed that some physicians are able to type their history of present illness while maintaining eye contact with their patient, only occasionally looking down at the screen.
For example, a description of smoking status will not count toward meeting meaningful use criteria if it is documented as free text in the history of present illness (or in the social history), but it will count toward fulfilling the criteria if it is entered as structured data in the area of the EHR that records and tracks tobacco use.
Two clinicians independently reviewed 144 asthma visits and evaluated three elements in each chart: history of present illness, physical examination, and assessment.
History of present illness; review of systems; and past, family and/or social history elements are highlighted as appropriate.