# COMAR Title 10 — Maryland Department of Health

## Subtitle 43 — Board of Chiropractic Examiners

### Chapter 14 — Record Keeping

#### Regulation .05 Patient History.

*COMAR 10.43.14.05*

The chiropractor shall include the following in the patient history:

A. Personal data, including:

  (1) Name,

  (2) Address,

  (3) Telephone number,

  (4) Date of birth,

  (5) Race,

  (6) Sex, and

  (7) Current occupation;

B. Complaint or complaints, including:

  (1) Description of the complaint or complaints,

  (2) Quality and character of the complaint or complaints,

  (3) Intensity,

  (4) Frequency,

  (5) Location,

  (6) Radiation,

  (7) Onset,

  (8) Duration,

  (9) Palliative and provocative factors, and

  (10) History of present complaint or complaints;

C. Family health history;

D. Past health history, including:

  (1) General state of health,

  (2) Previous illnesses,

  (3) Surgical history,

  (4) Previous injuries,

  (5) Hospitalizations,

  (6) Previous treatment and diagnostic testing,

  (7) Prescribed and nonprescribed medications and supplements,

  (8) Allergies, and

  (9) Mental illness;

E. Systems review, including:

  (1) Musculoskeletal,

  (2) Cardiovascular,

  (3) Respiratory,

  (4) Gastrointestinal,

  (5) Neurological,

  (6) Ophthalmological,

  (7) Otolaryngological,

  (8) Endocrine,

  (9) Peripheral vascular, and

  (10) Psychiatric; and

F. Personal history, including:

  (1) Occupational,

  (2) Activities,

  (3) Exercise, and

  (4) Health habits.