Clinical Assessment Tools (CAT):
Module 1 “Ninja” History-Taking Skills
Note: Right-click on links and choose “save link as” to download files to your computer.
“Ninja” History Taking Skills – Overview and Intro – Video (download link):
(Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Overview and Intro – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Presentation Slides
“Ninja” History-Taking Skills – Video Slides: View the slides that accompany the presentation and take notes as you follow along.
“Ninja” History-Taking Skills – Video Slides – 4 Slide Page: This is a more printer-friendly version of the slides with 4 slides per page. You can adjust your printer’s printing properties and select your printer’s “grayscale” color setting for best black and white results.
Tutorials
History Taking Guidelines: Guidelines for what to include in a thorough history.
History Taking Shortcuts: An easy to remember pneumonic for history of each of your health complaints.
Resources
Create Your Own Online Forms: Mach Forms software by Appnitro Inc. This is the software we use to create all of our online forms except the scorecards. Scorecards are a custom script created by a web programmer.
History Taking Skills:
Videos and Sample Forms
The sample forms are offered in the same order as they are presented in the videos. You can mix and match these with each client. A complete and comprehensive functional evaluation may include all of these components. Some questions you may choose to ask during your interview. Others you will prefer to have answered either using online versions of forms or printable versions. You will likely choose to customize and either add or remove certain questions that are not applicable to your mode of practice.
Quick Links to Videos
About Demographics and Values, Visions & Goals- About History of Chief Complaints and Review of Body Systems
- About Nutrition, Exercise, and Sleep
- About Stress
- About Medication, Supplements, and Environmental Exposues
- About Dental Evaluation
- About Past History and Family History
- About Scorecards and Wrap-Up
Quick Links to Forms:
Demographics and General Information- Health Values, Visions, and Goals
- History of Chief Complaints
- Review of Body Systems
- Dietary Habits
- Exercise Habits
- Sleep Habits
- Stress Evaluation and Risk Assessment
- Medication and Nutritional Supplements
- Environmental Exposures
- Dental Evaluations
- Past Health History
- Family History
- Scorecards: Organs & Glands and Nutrition
- Journals and Tracking
- “Ready and Willing” Assessment
About Demographics and Values, Visions, & Goals
“Ninja” History Taking Skills – Demographics and Goals – Video (download link): (Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Demographics and Goals – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Demographics and General Information – Forms
This form collects basic information like address, phone, height and weight, marital status and more. This is where you ask your client to share goals, provide an overview of their health issues and background, and give you a glimpse of their diet and lifestyle. This is intended to be used during a “Get to Know You” or Discovery Consultation, wherein you decide if this is a person you feel you can help, and they get to know your approach and decide if working together is a good match.
Note: The “Online Assessment Example” is an example of a Mach Form assessment used on a protected WordPress blog page. The settings can be adjusted so that both you and the client receive a copy of the information upon submission.
Demographics and General Information with Goals and Diet: Online Assessment Example (for Preview Only)
Demographics and General Information: Word Doc
Demographics and General Information: PDF Doc
Health Values, Visions, and Goals – Forms
In order to take the leap and make major diet and lifestyle changes, it’s important to create a big enough WHY. Getting in touch with values, visions, and goals and staying connected is the first step towards creating vibrant health and boundless energy.
Health Values, Visions, and Goals Form: Online Assessment Example
(for Preview Only)
Health Values, Visions, and Goals Form: Word Doc
Health Values, Visions, and Goals Form: PDF Doc
About History of Chief Complaint(s) and Review of Body Systems
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
WARNING: The above audio/video file(s) may be large and may take a long time to download.
History of Chief Complaint(s) – Forms
It’s important to do a thorough evaluation of your client’s chief complaints including the types of clarifying questions found in the History Taking Guidelines and History Taking Shortcuts documents. I find it to be most effective to collect pertinent data on the questionnaires then ask clarifying questions during the initial consultation.
History of Chief Complaint(s) Form: Online Assessment Example
(for Preview Only) This form gives the client the space to list and prioritize their top 10 health concerns.
History of Chief Complaint(s) Form: Word Doc
History of Chief Complaint(s) Form: PDF Doc
Review of Body Systems: Current Health and Exposures – Forms
Review of Body Systems: Online Assessment Example
(for Preview Only)
Review of Body Systems: Word Doc
Review of Body Systems: PDF Doc
About Nutrition, Exercise, and Sleep
“Ninja” History Taking Skills – Nutrition, Exercise, and Sleep – Video (download link): (Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Nutrition, Exercise, and Sleep – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Dietary Habits – Forms
Dietary Habits: Online Assessment Example
(for Preview Only) This is a thorough survey of food habits and preferences.
Food Frequency Checklist – Detailed: Online Assessment Example
(for Preview Only) This is helpful for designing elimination diets and identifying potential allergens and intolerance.
Dietary Habits: Word Doc
Dietary Habits: PDF Doc
Exercise Habits – Forms
Questions about exercise frequency, duration and type, along with response to exercise.
Exercise Habits: Word Doc
Exercise Habits: PDF Doc
Sleep Habits – Forms
Important questions to ask about sleep habits and environment to determine if your client’s challenges are in part related to sleep deprivation.
Sleep Habits: Word Doc
Sleep Habits: PDF Doc
About Stress
“Ninja” History Taking Skills – Stress – Video (download link):
(Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Stress – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Stress Evaluation and Risk Assessment – Forms
Use this form to assess the degree of stress your client has experienced in recent years, and determine how great an impact this is likely having on his or her health.
Stress Evaluation and Risk Assessment: Word Doc
Stress Evaluation and Risk Assessment: PDF Doc
About Medication, Supplements, and Environmental Exposures
“Ninja” History Taking Skills – Medications and Supplements – Video (download link): (Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Medications and Supplements – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Medication and Supplements – Forms
Medication and Supplements: Excel Spreadsheet for tracking Diet, Medications, and Supplements. This sheet is a valuable tool for tracking intake on a regular basis. You can use this as a starting point to customize your own. Once completed, have your client e-mail the results to you.
Medication and Supplements: Word Doc
Medication and Supplements: PDF Doc
Environmental Exposures – Forms
Environmental Exposures: Online Assessment Example
(for Preview Only) Take a close look at the environmental exposures that may be contributing to your client’s health challenges.
Environmental Exposures: Word Doc
Environmental Exposures: PDF Doc
About Dental Evaluation
“Ninja” History Taking Skills – Dental Evaluation – Video (download link):
(Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Dental Evaluation – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Dental Evaluation and History – Forms
Dental work can impact areas remote from the mouth. Evaluation of dental history can give clues about what’s going on inside.
Dental Evaluation and History: Word Doc
Dental Evaluation and History: PDF Doc
Tooth Organ Chart: PDF Doc – In Chinese medicine, each tooth is mapped to a specific organ. These charts are helpful in predicting the impact of dental problems on the rest of the body.
Tooth – Meridian – Emotions Chart: PDF Doc – What practitioners are they seeing and what services are being performed? Included are things like massage, chiropractic, acupuncture, herbal medicine, homeopathy and Western Medicine procedures as well. Questions pertaining to this category are asked in the Health Goals and Habits: Online Questionnaire.
About Past History and Family History
“Ninja” History Taking Skills – Past History and Family History – Video (download link): (Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Past History and Family History – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Past Health History – Forms
Past Health History: Online Assessment Example
(for Preview Only) This form delves into your client’s Past Health History helping you to ascertain what current imbalances are being influenced by early exposures and health challenges.
Past Health History: Word Doc
Past Health History: PDF Doc
Family Health History – Forms
Family Health History: Online Assessment Example
(for Preview Only) A compilation of your family’s history with respect to health, to aid in identifying genetic or environmentally acquired traits.
Family Health History Form: Word Doc
Family Health History Form: PDF Doc
About Scorecards and Wrap-up
“Ninja” History Taking Skills – Scorecards and Wrap-Up – Video (download link):
(Mp4)
Click on the audio player to listen to an audio-only recording. The recording may take a few moments to begin.
“Ninja” History Taking Skills – Scorecards and Wrap-Up – Audio (download link): (Mp3)
WARNING: The above audio/video file(s) may be large and may take a long time to download.
Organ and Gland Scorecards – Online Forms
Body System and Organ Assessment: This health assessment will examine and provide a score on the health of your digestion (5 parts), cardiovascular, kidney and bladder, and immune system health.
Hormone and Gland Assessment: This health assessment will examine your hormone balance (11 parts) for areas such as adrenal balance, blood sugar balance, thyroid balance, sex hormone balance, and more.
Brain and Neurotransmitter Assessment: This health assessment will examine and provide a score for your general brain function, serotonin, dopamine, GABA, and acetylcholine.
Detoxification Stress/Toxicity Assessment: This health assessment will measure your level of toxicity by examining conditions related to your digestion, ears, head, heart, emotions, joints/muscles, energy/activity, lungs, eyes, mind, skin, mouth/throat, weight, nose, and other indicators.
Candida and Parasite “Dysbiosis” Assessment: This health assessment probes into questions related to history that predisposes to dysbiosis and current symptoms that suggest an underlying candidiasis, fungal, parasitic or other microbial infestation.
Leaky Gut Assessment: This health assessment probes into questions related to signs and symptoms of leaky gut. You will receive a score that establishes your likelihood of leaky gut being a health challenge for you.
Nutrient Evaluation Scorecards – Online Forms
General Nutrient Balance Assessment: This health assessment will examine and provide a score on your clients’ general nutritional needs, essential fatty acid needs, and potential levels of amino acids.
Vitamin Balance Assessment:This health assessment will evaluate for signs and symptoms of imbalances of vitamins including A, B, B1, B2, B3, B5, B6, B7, B9, B12, C, D, E and K.
Mineral Balance Assessment: This health assessment will evaluate for signs and symptoms of imbalances of minerals including calcium, chromium, copper, iodine, iron, magnesium, manganese, phosphorus, potassium, and zinc.
Scorecards – Printable Versions
Toxicity Self-Assessment: Word Doc
Toxicity Self-Assessment: PDF Doc
Journals and Tracking Forms
Diet Diary, Supplements, and Medications Record: Online Assessment Example
(for Preview Only) Here’s a way for your client to record what they eat and what supplements they take.
Medication and Supplements: Excel Spreadsheet for tracking Diet, Medications, and Supplements. This sheet is a valuable tool for tracking intake on a regular basis. You can use this as a starting point to customize your own. Once completed, have your client e-mail the results to you. (copied from above)
“Ready and Willing” Assessment
The purpose of this assessment is to determine how ready and willing your client is to make the diet and lifestyle changes that will be required to succeed. A low score on this assessment means you’ll be working a lot on attitude and perhaps emotional barriers.
“Ready and Willing” Assessment: Word Doc
“Ready and Willing” Assessment: PDF Doc
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