Acute Case Taking

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Department of Case Taking & Repertory

The Calcutta Homoeopathic Medical College & Hospital


(Government of West Bengal)

Case Taking Proforma (For Acute / Short Case)

1. IDENTIFICATION:

OPD Regd. No. –……………….. IPD Regd. No. – …………… Ward – …….. Bed No. – ….

Name – ………………………….. Age – ……… Sex – ………. Religion – ………................

Address – …………………………………………….................................................................

Police Station – …………………… Contact No. …………… Email id: .................................

Occupation – …………...... Date of Admission – ………... Date of examination – ………….

Visiting Physician – ………………………………..

2. PRESENT COMPLAINTS:
(a) PRESENT COMPLAINTS IN DETAILS: (Location/Extension, Sensation/Physical
Character, Modalities, Concomitants and Duration)

(b) HISTORY OF THE PRESENT ILLNESS: (Cause;Mode of Onset; Present complaints


whether before, during or after taking the medicine; Treatment adopted and result;
Any other special information)

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3. OTHER IMPORTANT SYMPTOMS AND FINDINGS INCLUDING CLINICAL
FINDINGS:

4. PROVISIONAL DIAGNOSIS:

5. LABORATORY INVESTIGATIONS:

6. CONFIRMED DIAGNOSIS:

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7. ANALYSIS OF SYMPTOMS/ CATEGORISATION OF SYMPTOMS/ ANALYSIS
& EVALUATION OF SYMPTOMS

8. TOTALITY OF SYMPTOMS:(Theoretical order of TOS as per Kentian Philosophy –


i) Causation: a) Fundamental, b) Exciting, c) Maintaining
ii) Characteristic Mental General iii) Characteristic Physical General
iv) Characteristic Particular; Important Physical Findings
v) Important Laboratory Finding;
This order may be changed during clinical application of TOS according to intensity of
the symptoms in respect of Acute / Short case)
For BTPB / BBCR TOS will be according Theoretical order –

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9. CONVERSION OF SYMPTOMS INTO RUBRIC WITH PAGE NO.:

10. REPERTORISATION:

11. ANALYSIS OF REPERTORIAL RESULT:

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12. REPERTORIAL SELECTION WITH REASON:

13. FINAL SELECTION OF MEDICINE (AFTER CONSULTATION WITH


MATERIA MEDICA WITH REASONS)

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