General Medical Test (HCW)

    Bye waiting room.
    Hello online doctor.

    *Your Address:

    *Age:

    Do you often feel fatigue, exhaustion?
    YesNo

    Are you losing your appetite?
    YesNo

    Are you losing on your weight?
    YesNo

    Do you have increased body temperature?
    YesNo

    Do you occasionally feel nausea?
    YesNo

    Do you feel your mouth dry?
    YesNo

    Do you have pyrosis?
    YesNo

    Are you vomiting?
    YesNo

    Do you have bloating and gas in your stomach?
    YesNo


    Stomach pain:

    Do you have stomach pain? A) upper part b)middle c)lower part
    upper partmiddlelower partI have no stomach pains

    If you have stomach pain, whether the stomach pain is:
    severemoderate

    Does the pain go towards the spine?
    YesNo


    Do you have diarrhea?
    YesNo

    Do you have constipation (stool in 2-3 days)?
    YesNo

    Whether your stool is colorless?
    YesNo

    Whether your stool has a dark color (coffee color)?
    YesNo

    Can you notice the presence of fresh blood in the stool?
    YesNo


    Headache suffering:

    Are you suffering from a headache?
    YesNo

    If yes, for how long do you suffer from a headache? A) nowadays b) for a long time
    nowadaysfor a long timeI have no a headache

    How often you have a headache?
    each dayonce a weekonce a monthrarely

    Whether is it a headache?
    severemoderate

    When having a headache, do you vomit?
    YesNo


    Do you have vertigo, dizziness?
    YesNo

    Do you have tinnitus (buzzing in your ears)?
    YesNo


    Eye:

    Do you have problems with your vision (eye problems)?
    YesNo

    Do you have any of these eyes problems:

    Eye strain?
    YesNo

    Do you have color blindness?
    YesNo


    Do you know if you have high blood pressure?
    YesNo

    Do you feel a throbbing heart?
    YesNo

    Do you have chest pain?
    YesNo

    Is your neck swollen?
    YesNo

    Do you swallow hard?
    YesNo

    Do you smoke?
    YesNo

    Do you get tired during the short walk?
    YesNo

    Do you have swelling around the ankles?
    YesNo

    Do you feel pain in the lower legs during the short walk?
    YesNo

    Do you have an urge for frequent urination?
    YesNo

    Is urination painful?
    YesNo

    What is the color of urine?
    redlike beernormal color

    Do you feel itching while urinating?
    YesNo

    Do you have pain in your spine?
    YesNo

    Do you have pain in your joints?
    YesNo

    Whether your periods are painful?
    YesNo

    Whether you have increased secretion from the genital organs?
    YesNo

    Do you have breast pain?
    YesNo

    Do you feel any growth on the breast?
    YesNo

    Do you have breast secretion?
    YesNo

    Do you have a cough?
    YesNo

    Whether the cough is:
    drywith secretions

    Do you have a sense of suffocation? (hard for you to take a breath)
    YesNo

    Do you drink alcohol?
    YesNo

    Do you feel your left or right side of the body tingling?
    YesNo

    Do you have any skin changes? A)redness b) itching c)dandruff d)naevus e)papula
    rednessitchingdandruffnaevuspapula

    Are you nervous?
    YesNo

    Do you have any growths in the groin area?
    YesNo

    Do you have pain in the navel area?
    YesNo

    Do you have any growths in the navel area?
    YesNo

    Do you use any drugs?
    YesNo


    Please add any other symptoms / health-related complaints
    or various information about your health status (information
    not listed in the test):

    Date of completion of the test: