General Medical Test (HCW) Bye waiting room. Hello online doctor. * Your Name * Your Email *Your Address: *Age: under 2525-4545-60over 60 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: redness of the eyesthick secretion in or around the eyesburningfeeling of a foreign bodyitchingfeeling of grit in the eyestearfeeling dry in the eyeslight sensitivity 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 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: