1. FEVER

• High or low grade
• Longer than 30 days
• Continuous, intermittent (on and off), or occasional
• Did the fever rise every day
• Repeated attacks with chills, shaking, sweating, or muscle pain
• Associated with: headache; burning sensation while passing urine; neck stiffness; irritated and does not like light or sound; confusion; drowsiness; coma; rash/blisters

2. COUGH

• Dry, wet (with sputum), bloody (rusty), or foul smelling
• Longer than 30 days
• Worse during day or night
• With wheezing or in-­drawing of chest (use local language)
• Any pain during cough or deep breath
• Any pain at the sides of the chest wall
• Associated with: night sweats; evening rise of temperature; vomiting; hoarseness of voice

3. BREATHLESSNESS

• What brings it on (for example, allergy or chest infection)
• Progression: did the person feel breathlessness only during exertion? Did it progressively worsen so that breathlessness occurred also at rest?
• Worse after lying flat, and relieved by sitting up
• Continuous or in episodes/attacks
• Associated with: night sweats; evening rise of temperature; vomiting; hoarseness of voice

4. DIARRHOEA/DYSENTERY IN STOOLS

• Were the stools liquid or semisolid
• Did stools contain mucus, or look like rice water
• Longer than 30 days
• Painless or painful
• Large quantity or not
• Blood in the stool, red or black in colour
• How many times a day at worst
• Associated with: vomiting; very thirsty; dehydration; sunken eyes

5. WEIGHT LOSS

• Loss of weight rapid in last 2-3 months
• Associated with prolonged fever for more than 1 month (either constant or continuous)
• Diarrhoea for more than 1 month
• Persistent cough for more than 1 month
• Swelling in arm pits, neck, groin
• Itching and skin rash
• White sores or white patches in mouth
• History of tuberculosis

6. CHEST PAIN

• Onset: sudden or gradual
• Did pain last more than 24 hours or less than 24 hours
• Location: chest, upper stomach, or back
• Did pain spread? To left arm, deep central chest, hand, shoulder, or back?
• Pain worse with walking, exertion, cough or deep breath, touching the area, or eating
• Associated with: sweating; vomiting

7. PARALYSIS/STROKE

• Onset: over minutes, hours, or noticed after waking up
• Accompanied by sudden loss of consciousness
• Which part of body was paralyzed (i.e., half of body, one arm, right/left face)?
• Time of onset: during activity or in sleep
• Associated with: vomiting; headache; loss of memory; loss of vision or speech; neck stiffness

8. OEDEMA (SWELLING)

• Location: hands, feet, abdomen, or elsewhere
• Onset: sudden or gradual
• Worse at night or morning
• Associated with: worse with walking; fatigue; feeling the heart beat faster; nausea; loss of appetite

9. URINARY PROBLEMS

• Reduced urine amount or more frequent passage of urine
• Burning sensation while urinating
• Urine contained pus or blood
• Intense desire to pass more urine even after the bladder has been emptied
• Associated with: pain in lower abdomen; tenderness in the side of abdomen; sudden onset of pain in one or both loins, spreading to lower abdomen; paleness; nausea; vomiting; became dull, drowsy or unconsciousness

10. GASTRO-INTESTINAL TRACT (ABDOMINAL) PROBLEMS

• Was there pain? Describe the location; type (i.e., burning); and onset (sudden or gradual)
• If pain, describe periodicity: did it occur in episodes or continuous? How long each episode?
• Relationship to food: more pain on empty stomach? Was it relieved after taking food?
• Difficulty in swallowing solid or liquid food
• Did pain wake person from sleep?
• Onset of abdominal distension: sudden or gradual
• Associated with: loss of appetite, nausea; constipation; black stools; vomiting with blood; sweating; history of surgery or trauma or cancer; history of lump/mass in abdomen; alcohol abuse

11. JAUNDICE  (YELLOWNESS IN THE WHITE PART OF EYES OR SKIN)

• What become yellow: eyes or skin; was urine dark yellow/brown?
• Onset: yellowness came first followed by other illness OR illness came first followed by yellowness
• Associated with: vomiting blood; alcohol abuse; history of cancer

12. SEIZURES/ FITS

• Previous episodes of sudden jerky movements of arms or legs
• Loss of consciousness
• Awake between fits or not
• Associated with: rolling of eye balls; frothing of mouth; loss of memory; bit tongue; bed wetting; confused; history of head injury