A review of systems is a technique used by health-care providers for eliciting a history from a patient. It is often structured as a component of an admission note

Admission note

An admission note is part of a medical record that documents the patient's status, reasons why the patient is being admitted for inpatient care to a hospital or other facility, and the initial instructions for that patient's care...

 covering the organ systems, with a focus upon the subjective symptom

Symptom

A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

s perceived by the patient (as opposed to the objective sign

Medical sign

A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....

s perceived by the clinician). It can be particularly useful in identifying conditions that don't have precise diagnostic tests.

Examples

Whatever system

System

System is a set of interacting or interdependent components forming an integrated whole....

 a specific condition may seem restricted to, it may be reasonable to review all the other systems in a comprehensive history. Different sources describe slightly different systems of organizing the organ systems. However, the following are examples of what can be included:

There are 14 systems recognized by the CMS:

System	Examples
Constitutional symptoms Constitutional symptoms Constitutional symptoms refers to a group of symptoms that can affect many different systems of the body.Examples include Weight loss, fevers, fatigue, and malaise.Other examples include chills, night sweats, and decreased appetite....  (e.g., fever Fever Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in... , weight loss Weight loss Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue... )	unexplained weight loss Weight loss Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue... , night sweats, fatigue/malaise Malaise Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"... /lethargy, sleeping pattern, appetite Appetite The appetite is the desire to eat food, felt as hunger. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Decreased desire to eat is... , fever Fever Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in... , itch Itch Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response... /rash Rash A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and... , recent trauma Physical trauma Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death... , lump Lump Lump is a 2000 greatest hits compilation album by The Presidents of the United States of America.The album includes three covers: "Video Killed the Radio Star", originally by The Buggles, "Kick Out the Jams", originally by MC5 and "Cleveland Rocks", originally by Ian Hunter.Unusual for a "Greatest... s/bumps/masses, unexplained falls
Eye Human eye The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth... s	visual changes, headache Headache A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the... , eye pain, double vision Diplopia Diplopia, commonly known as double vision, is the simultaneous perception of two images of a single object that may be displaced horizontally, vertically, or diagonally in relation to each other... , scotomas (blind spots), floaters or "feeling like a curtain got pulled down" (retinal hemorrhage vs amaurosis fugax Amaurosis fugax Amaurosis fugax is a transient monocular visual loss.-Pathophysiology and etiology:... )
Ears, nose, mouth, and throat (ENT)	Runny nose, frequent nose bleeds (epistaxis), sinus pain Sinusitis Sinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days... , stuffy ears, ear pain, ringing in ears (tinnitus Tinnitus Tinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear... ), gingival bleeding, toothache Toothache A toothache, also known as odontalgia or, less frequently, as odontalgy, is an aching pain in or around a tooth.-Causes:* Dental etiology, In most cases toothaches are caused by problems in the tooth or jaw, such as** Dental caries... , sore throat Sore throat A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain.... , pain with swallowing (odynophagia Odynophagia Odynophagia is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia, or difficult swallowing.... )
Cardiovascular	chest pain Chest pain Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential... , shortness of breath, exercise intolerance Exercise intolerance Exercise intolerance is a condition where the patient is unable to do physical exercise at the level or for the duration that would be expected of someone in his or her general physical condition, or experiences unusually severe post-exercise pain, fatigue, or other negative effects... , PND, orthopnoea Orthopnoea Orthopnea or orthopnoea is shortness of breath which occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair... , oedema, palpitation Palpitation A palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself... s, faintness, loss of consciousness, claudication Claudication Claudication, literally 'limping' , is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest. The perceived level of pain from claudication can be mild to extremely severe. Claudication is most...
Respiratory	cough Cough A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes... , sputum Sputum Sputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections.... , wheeze Wheeze A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed, or airflow velocity within the respiratory tree must be heightened... , haemoptysis, shortness of breath, exercise intolerance Exercise intolerance Exercise intolerance is a condition where the patient is unable to do physical exercise at the level or for the duration that would be expected of someone in his or her general physical condition, or experiences unusually severe post-exercise pain, fatigue, or other negative effects...
Gastrointestinal	abdominal pain Abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem... , unintentional weight loss Weight loss Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue... , difficulty swallowing (solids vs liquids), indigestion, bloating, cramping, anorexia, food avoidance, nausea Nausea Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting... /vomiting Vomiting Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose... , diarrhea Diarrhea Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and... /constipation Constipation Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation... , inability to pass gas (obstipation), vomiting blood (haematemesis), bright red blood per rectum (BRBPR, hematochezia Hematochezia Hematochezia is the passage of fresh blood per anus, usually in or with stools . Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper GI bleed... ), foul smelling dark black tarry stools (melaena), dry heaves of the bowels (tenesmus Tenesmus Rectal tenesmus is a feeling of incomplete defecation. It is experienced as an inability or difficulty to empty the bowel at defecation... )
Genitourinary	Urinary: Irritative vs Obstructive symptoms: Micturition - incontinence Urinary incontinence Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners... , dysuria Dysuria In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria.... , haematuria, nocturia Nocturia Nocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly... , polyuria Polyuria Polyuria is a condition usually defined as excessive or abnormally large production or passage of urine . Frequent urination is sometimes included by definition, but is nonetheless usually an accompanying symptom... , hesitancy, terminal dribbling, decreased force of stream Genital: Vaginal - discharge, pain, Menses - frequency, regularity, heavy or light (ask about excessive use of pads/tampon Tampon A tampon is a mass of cotton or rayon or a mixture of the two inserted into a body cavity or wound to absorb bodilyfluid. The most common type in daily use is designed to be inserted into the vagina during menstruation to absorb the flow of menstrual fluid... s, staining of clothes, clots always indicate heavy bleeding), duration, pain, first day of last menstrual period (LMP), gravida/para/abortus Gravida/para/abortus Gravida/para/abortus , or sometimes just gravida/para , is a shorthand notation for a woman's obstetric history.* Gravida indicates the number of times the mother has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this... , menarche Menarche Menarche is the first menstrual cycle, or first menstrual bleeding, in female human beings. From both social and medical perspectives it is often considered the central event of female puberty, as it signals the possibility of fertility.... , menopause Menopause Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining... , contraception Contraception Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...  (if relevant), date of last smear test and result
Musculoskeletal	pain Pain Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."... , misalignment, stiffness Stiffness Stiffness is the resistance of an elastic body to deformation by an applied force along a given degree of freedom when a set of loading points and boundary conditions are prescribed on the elastic body.-Calculations:...  (morning vs day long; improves/worsens with activity), joint Joint A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...  swelling, decreased range of motion Range of motion Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields... , crepitus Crepitus Crepitus is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints.-Causes:... , functional deficit, arthritis Arthritis Arthritis is a form of joint disorder that involves inflammation of one or more joints....
Integumentary	pruritus, rash Rash A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and... es, stria, lesions, wounds, incisions, acanthosis nigricans Acanthosis nigricans Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the axilla, groin, umbilicus, forehead, and other areas.-Causes:... , nodule Nodule Nodule may refer to:*Nodule , a small knobbly rock or mineral cluster, such as a manganese nodule*Nodule , a small aggregation of cells*Nodule , a lesion similar to a papule... s, tumors, eczema Eczema Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions... , excessive dryness and/or discoloration.
Neurological	Special senses Special senses In medicine and anatomy, the special senses are the senses that have specialized organs devoted to them:*vision *hearing and balance *smell *taste...  - any changes in sight Visual perception Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision... , smell Olfaction Olfaction is the sense of smell. This sense is mediated by specialized sensory cells of the nasal cavity of vertebrates, and, by analogy, sensory cells of the antennae of invertebrates... , hearing Hearing (sense) Hearing is the ability to perceive sound by detecting vibrations through an organ such as the ear. It is one of the traditional five senses...  and taste Taste Taste is one of the traditional five senses. It refers to the ability to detect the flavor of substances such as food, certain minerals, and poisons, etc.... , seizure Seizure An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness... s, faint Faint Faint may refer to:* Syncope , a medical term for fainting* Faint , a song by Linkin Park* Feint, a maneuver designed to distract or mislead* Feint , a song by Epica* The Faint, a dance-punk/rock band.... s, fit Fit Fit or FIT may refer to:Fitness* Physical fitness, how well a person is suited for physical tasks* FitTV, cable television network about physical fitness* Wii Fit, Nintendo Wii video game about physical fitness... s, funny turns, headache Headache A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the... , pins and needles (paraesthesiae) or numbness, limb weakness Weakness Weakness is a symptom represented, medically, by a number of different conditions, including: lack of muscle strength, malaise, dizziness, or fatigue. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a... , poor balance, speech problems, sphincter disturbance, higher mental function and psychiatric symptoms
Psychiatric	depression Clinical depression Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities... , sleep patterns, anxiety Anxiety Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,... , difficult concentrating, body image, work and school performance, paranoia, ahedonia, lack of energy, episodes of mania, episodic change in personality, expansive personality, sexual or financial 'binges',
Endocrine	Hyperthyroid: prefer cold weather, mood swings Mood Swings Mood Swings is an album by Koby Israelite released in 2005 on Tzadik.- Track listing :# "Dror Ikra" - 3:03# "Return of the Idiots" - 2:19# "It Is Not a War Here" - 7:05# "Ethnometalogy" - 5:08# "Europa?" - 2:49# "Hiriya On My Mind" - 4:53... , sweaty, diarrhoea, oligomenorrhoea, weight loss Weight loss Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...  despite increased appetite, tremor Tremor A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the... , palpitation Palpitation A palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself... s, visual disturbances; Hypothyroid - prefer hot weather, slow, tired Tired Tired may refer to:* Fatigue , a feeling of exhaustion* "Tired", a song by Rollins Band on Weight from 1994* "Tired", a song by Willa Ford on Willa Was Here from 2001* "Tired", a song by LCD Soundsystem on LCD Soundsystem from 2005... , depressed Depression (mood) Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless... , thin hair, croaky voice, heavy periods, constipation Constipation Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation... , dry skin Diabetes: polydipsia Polydipsia Polydipsia is a medical symptom in which the patient displays excessive thirst. The word derives from the Greek πολυδιψία, which is derived from πολύς + δίψα... , polyuria, polyphagia (constant hunger without weight gain is more typical for a type I diabetic than type II), symptoms of hypoglycemia such as dizziness, sweating, headache,hunger, tongue dysarticulation Adrenal: difficult to treat hypertension, chronic low blood pressure, orthostatic symptoms, darkening of skin in non-sun exposed places Reproductive (female): menarche, cycle duration and frequency, vaginal bleeding irregularities, use of birth control pills Reproductive (male): difficulty with erection or sexual arousal, depression, lack of stamina/energy
Hematologic/lymphatic	anemia Anemia Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin... , purpura Purpura Purpura is the appearance of red or purple discolorations on the skin that do not blanch on applying pressure. They are caused by bleeding underneath the skin... , petechia Petechia A petechia is a small red or purple spot on the body, caused by a minor hemorrhage ."Petechiae" refers to one of the three major classes of purpuric skin conditions. Purpuric eruptions are classified by size into three broad categories... , results from routine hemolytic diseases screening, prolonged or excessive bleeding after dental extraction / injury, use of anticoagulant and antiplatelet drugs (including aspirin Aspirin Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer... ), family history of hemophilia, history of a blood transfusion, refused for blood donation
Allergic/immunologic	"Difficulty breathing" or "choking" (anaphylaxis Anaphylaxis Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure... ) as a result of exposure to anything (and state what; e.g. "bee sting"). Swelling or pain at groin Groin In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles... (s), axilla(e) or neck (swollen lymph node Lymph node A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as... s/gland Gland A gland is an organ in an animal's body that synthesizes a substance for release of substances such as hormones or breast milk, often into the bloodstream or into cavities inside the body or its outer surface .- Types :... s), allergic response (rash/itch) to materials, foods, animals (e.g. cats); reaction to bee sting, unusual sneezing (in response to what), runny nose or itchy/teary eyes; food, medication or environmental allergy test(s) results.

The questions may be asked of the patient in a "head to toe" manner.

Relationship to history

For CMS

Centers for Medicare and Medicaid Services

The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...

, a "problem pertinent" ROS is limited to the problem(s) identified in the HPI; an "extended" ROS covers an additional 2 to 9 systems, and a "complete" ROS covers at least 10 additional systems.