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— Case sheet

Present complaints

Location

Sensation

Concomitant

Modality

Side

Physical generals

Thermals

Thirst

Sleep

Dreams

Appetite

Bowels / bladder

Investigations and history

Any investigations?

Past history (illness)

Surgery

Vaccination

Allergic medicines

Current medication

Gynae / Obs historyFemale

Menses flow

Menses cycle

Associated complaints

Menarche age

Menopause age

H/O abortions / pregnancies

General history and sensitivities

Build

Hair

Pigmentation

Perspiration

Sensitivities — sun, noise, light, touch, clothing, odors

Mind

Treatment

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Total billed

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Collected

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Pending

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REMEDY IDENTIFICATION	1ST POTENCY GROUP	HIGHER POTENCIES GROUP	LM POTENCY GROUP
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Age

Gender

Phone

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Treatment (optional)

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SpO2 %

Temp °F

Weight kg

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REMEDY IDENTIFICATION		1ST POTENCY GROUP								HIGHER POTENCIES GROUP					LM POTENCY GROUP
INFO PARAMETERS		MT	TRITURATION (X)			CENTESIMAL (C)				CENTESIMAL (C)					50-MILLESSIMAL (LM)
SLNo	Product	MT	3X	6X	12X	3C	6C	12C	30C	200C	1M	10M	50M	CM	0/1	0/2	0/3	0/4	0/5
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