Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 1A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30 min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness,

NO rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_________________

Patient 1B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - epigastric or periumbilical to RLQ

Direct RLQ tenderness,

NO rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 1C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ to RLQ

Direct RLQ tenderness,

NO rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:______________________

Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 2A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and REBOUND RLQ

tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 2B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - epigastric or periumbilical to RLQ

Direct and REBOUND RLQ

tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 2C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ to RLQ

Direct and REBOUND RLQ

tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 3A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and rebound RLQ

tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 3B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - epigastric or periumbilical to RLQ

Direct and rebound RLQ

tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 3C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ to RLQ

Direct and rebound RLQ

tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 4A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, WITH

guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 4B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - epigastric or periumbilical to RLQ

Direct RLQ tenderness, WITH

guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 4C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ to RLQ

Direct RLQ tenderness, WITH

guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 5A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Rebound RLQ tenderness, NO

direct tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 5B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - epigastric or periumbilical to RLQ

Rebound RLQ tenderness, NO

direct tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 5C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

With shifting pain - LLQ to RLQ

Rebound RLQ tenderness, NO

direct tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 6A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, NO

rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 6B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound RLQ

tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 6C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound RLQ

tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 6D: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, WITH

guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

Yellowish vaginal discharge

Not pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Female Patients 15-50 years old with RLQ Pain and Tenderness with Various Associated Symptoms and Signs

Patient 7A: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, NO

rebound, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 7B: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound RLQ

tenderness, NO guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 7C: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct and Rebound RLQ

tenderness, WITH guarding

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________

Patient 7D: Sex: Female Age: 15-50 years old

Clinical Findings and Data

(With 2 physical exams within 30min)

Primary Clinical Diagnosis

(Tick one only)

Secondary Clinical Diagnosis

(Tick one only)

Degree of Certainty of Clin. Diagnosis

(Tick one only)

Ancillary Diagnostic Procedure

(Tick one only)

RLQ PAIN AND TENDERNESS

Onset: <7 days

Started in and confined to RLQ

Direct RLQ tenderness, WITH

guarding, NO rebound

No bowel movement disturbance

No urinary disturbance

No vaginal discharge

Pregnant-suspect

No other associated symptoms/signs

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Appendicitis

( ) Urinary tract infection

( ) Ureteral stone

( ) Gastroenteritis

( ) Pelvic inflammatory disease

( ) Ectopic pregnancy-related pain

( ) Normal pregnancy-related pain

( ) Nonspecific RLQ pain/tenderness

( ) Others:

_____________________________

( ) Certain that I will proceed to

treatment without requesting

for any ancillary diagnostic

procedure.

( ) Uncertain that I will request for

an ancillary diagnostic

procedure (observation included)

( ) Observation without lab initially

( ) CBC

( ) Urinalysis

( ) CBC and urinalysis

( ) Ultrasound of lower abdomen

and pelvis

( ) CBC and urinalysis and

ultrasound, pelvis & lower abd

( ) CT scan

( ) Pregnancy test (urine)

Others:_______________________