The chiropractor shall include the following in the patient history:

1. A. Personal data, including:

   1. (1) Name,
   2. (2) Address,
   3. (3) Telephone number,
   4. (4) Date of birth,
   5. (5) Race,
   6. (6) Sex, and
   7. (7) Current occupation;

2. B. Complaint or complaints, including:

   1. (1) Description of the complaint or complaints,
   2. (2) Quality and character of the complaint or complaints,
   3. (3) Intensity,
   4. (4) Frequency,
   5. (5) Location,
   6. (6) Radiation,
   7. (7) Onset,
   8. (8) Duration,
   9. (9) Palliative and provocative factors, and
   10. (10) History of present complaint or complaints;
3. C. Family health history;

4. D. Past health history, including:

   1. (1) General state of health,
   2. (2) Previous illnesses,
   3. (3) Surgical history,
   4. (4) Previous injuries,
   5. (5) Hospitalizations,
   6. (6) Previous treatment and diagnostic testing,
   7. (7) Prescribed and nonprescribed medications and supplements,
   8. (8) Allergies, and
   9. (9) Mental illness;

5. E. Systems review, including:

   1. (1) Musculoskeletal,
   2. (2) Cardiovascular,
   3. (3) Respiratory,
   4. (4) Gastrointestinal,
   5. (5) Neurological,
   6. (6) Ophthalmological,
   7. (7) Otolaryngological,
   8. (8) Endocrine,
   9. (9) Peripheral vascular, and
   10. (10) Psychiatric; and

6. F. Personal history, including:

   1. (1) Occupational,
   2. (2) Activities,
   3. (3) Exercise, and
   4. (4) Health habits.

Authority: Health Occupations Article, §3-205, Annotated Code of Maryland

Effective date: February 23, 1998 (25:4 Md. R. 244)

Regulation .02B amended effective June 13, 2011 (38:12 Md. R. 705)

Regulation .03B amended effective October 22, 2007 (34:21 Md. R. 1915)

Chapter and Subtitle renamed and recodified from COMAR 10.43.15 to COMAR 10.43.14, Board of Chiropractic Examiners, Record Keeping, effective January 2, 2017 (43:26 Md. R. 1446)

Regulation .03C amended effective December 30, 2019 (46:26 Md. R. 1165)

Regulation .04A amended effective December 30, 2019 (46:26 Md. R. 1165)