History of the present illness

Following the chief complaint in medical history taking, a history of the present illness (abbreviated HPI)[1] (termed history of presenting complaint (HPC) in the UK) refers to a detailed interview prompted by the chief complaint or presenting symptom (for example, pain).

Questions to include

Different sources include different questions to be asked while conducting an HPI.

Several acronyms have been developed to categorize the appropriate questions to include.

The Centers for Medicare and Medicaid Services has published criteria for what constitutes a reimbursable HPI. A "brief HPI" constitutes one to three of these elements. An "extended HPI" includes four or more of these elements.[2][3]

or "PQRST"[6][7]
("S" = Symptoms)
location "L": Location "R": Region and Radiation "L" : Location "L": Location "L": Location "L:" Location "L:" Location
quality "C": Character "Q": Quality of the pain "C": Character "C": Character "Q": Quality "C:" Characteristics "C": Character
"R": Radiation "R": Radiation see above "R": Radiation
severity "S": Severity-how disruptive "S": Severity "S": Severity "S": Severity "I": Intensity see above "S": Severity
duration "O": Onset

"D": Duration

"O": Onset "T": Time "T": Time frame "O": Onset "O:" Onset
"H:" History
"D:" Duration
timing "T:" Timing "T": Time see above see above see above see above "O": Onset
context "A": Aggravating factors "E": Environment
modifying factors "R": Relieving factors "P": Provocation or Palliation "A" Alleviating/Aggravating Factors "E": Exacerbation "A": Aggravating factors "A:" Aggravating factors "E:" Exacerbation
"A": Alleviation "A": Alleviating factors "R:" Remitting factors "R:" Remitting factors
associated signs & symptoms "O": Other symptoms "A": associated symptoms "A": Associated symptoms see above "A": Associated symptoms

Also usable is SOCRATES. For chronic pain, the Stanford Five may be assessed to understand the pain experience from the patient's primary belief system.

Medicare definitions

CMS required history elements[11]
Type of history CC HPI ROS Past, family, and/or social
Problem focused Required Brief N/A N/A
Expanded problem focused Required Brief Problem pertinent N/A
Detailed Required Extended Extended Pertinent
Comprehensive Required Extended Complete Complete

See also


  1. Adler HM (1997). "The history of the present illness as treatment: who's listening, and why does it matter?". J Am Board Fam Pract. 10 (1): 28–35. PMID 9018660.
  2. Evaluation and Management Coding and Electronic Health Records
  3. http://www.usc.edu/health/uscp/compliance/tm6.html#6 Archived 2001-05-03 at the Wayback Machine
  4. Medical Assessment
  5. Learning To Perform a Medical Assessment – Part 1: Quick Medical Assessment
  6. WEMSI – Assessment by PQRST
  7. Department of Medicine Home Page
  8. Dartmouth Medicine Magazine :: Student Notebook
  9. HPI (history of present illness)
  10. Buring SM, Kirby J, Conrad WF (February 2007). "A structured approach for teaching students to counsel self-care patients". Am J Pharm Educ. 71 (1): 8. doi:10.5688/aj710108. PMC 1847542. PMID 17429508.
  11. "Evaluation and Management Services Guide" (PDF). www.cms.gov. December 2010. Archived from the original (PDF) on 2012-04-11. Retrieved 2011-02-27.
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