A homoeopathic case taking proforma records the patient as a whole: the complaints as narrated by the patient, each complaint in detail as a Complete Symptom (Location, Sensation, Modalities), concomitants, history and causation, past, family and personal history, physical and mental generals, clinical examination, and then analysis, evaluation, miasmatic analysis, totality, repertorisation and the final selection of medicine. Below is the full institutional format with a free printable proforma. HomeoNetix, homeopathy clinic software for doctors in India, records a case in the same order.
At a glance
01
Let the patient speak first and write their expressions as they say them. Spontaneous descriptions are often the most characteristic symptoms in the case; paraphrasing loses them. The questions on the proforma are only suggestive, and the patient should not be restricted to them.
02
Each complaint is recorded with its three parts. Location and extension: exactly where the sensation, pain or eruption is, and where it spreads. Sensation or physical character: how it feels to the patient. Modalities: what makes the trouble better or worse.
03
Concomitants are complaints that appear along with the main complaint but are not part of it, such as profuse urination with a headache or thirstlessness during fever. Causation is what the illness began after: an injury, grief, fright or getting wet. Neither is a fourth part of the Complete Symptom; each is its own heading because each can point to a remedy on its own.
04
Past illnesses since childhood, operations, treatment and result; family health and causes of death on both sides; and personal history: habits, addictions, diet, living and working situation, milestones and vaccinations in children.
05
Physical generals describe the patient as a whole; mental generals describe disposition and behaviour. Dreams and willingness to change are recorded under mental, as HomeoNetix does.
06
General survey and systemic examination, provisional diagnosis, laboratory investigations and confirmed diagnosis. These guide prognosis and management even though the prescription rests on the totality.
07
Analyse and evaluate the symptoms, marking the strange, rare and peculiar. Assess the miasm from history, generalities and particulars (Psora, Sycosis, Syphilis). Build the totality, including fundamental, exciting and maintaining causes; convert symptoms into rubrics; repertorise; and make the final selection after consulting the materia medica, with reasons.
08
At each visit, record what is better, worse, the same, new or resolved, and the treatment response. Add each follow-up to the case instead of rewriting earlier visits, so the case reads as a timeline.
Free download
The institutional format taught in Indian homoeopathic colleges, arranged the way HomeoNetix records a case. Print it, or choose “Save as PDF” in the print window.
Case Taking Proforma
Complete Symptom = Location · Sensation · Modalities. Concomitants and causation are recorded separately.
Sex: Male / Female / Other
Diet: Veg. / Non-veg.
Marital status: Single / Married / Divorced / Widow / Widower
Questions and language here are merely suggestive, intended to lead the patient to give all their symptoms. The patient should not be restricted to the language or symptoms of the proforma.
In the patient’s own words.
Complaints or symptoms that appear along with the main complaint.
Cause, mode of onset, treatment already adopted and result; any other special information.
From head to feet, under the same headings as above.
Past illness including operations since childhood, treatment done and result. History during pregnancy; birth history in the case of children.
Circle all major illnesses suffered so far and give details below.
| Disease suffered from | Age (approx.) | Duration | Medication taken | Fully recovered? |
|---|---|---|---|---|
Health or cause of death on the paternal side, maternal side, brothers, sisters and children. Major diseases: anaemia, cancer, diabetes, insanity, rheumatism, T.B., leprosy, epilepsy, bleeding tendency, urticaria, eczema or other skin disease, asthma, paralysis, hypertension, heart, kidney or liver disease, depression, suicidal attempt.
| Relationship | Alive / dead | Age | Disease suffered (since when) | Cause of death |
|---|---|---|---|---|
| Paternal grandfather | ||||
| Paternal grandmother | ||||
| Maternal grandfather | ||||
| Maternal grandmother | ||||
| Father | ||||
| Mother | ||||
| Brother(s) | ||||
| Sister(s) | ||||
| Children | ||||
| Others with a similar complaint |
Habits and hobbies, dietetic errors, living environment, occupational hazards, relations with family and at work, sterilisation / contraceptives, medicines taken regularly, life situation.
Alcohol, smoking, tobacco, supari, pan, cannabis or other drugs; also internet, shopping, etc.
| Milestone | Age at which it started | Problems |
|---|---|---|
| Teething | ||
| Sitting | ||
| Standing | ||
| Walking with support | ||
| Walking without support | ||
| Speaking | ||
| Urine control |
| Vaccine given | Age | Complaints after vaccination | How long they lasted |
|---|---|---|---|
Bowel: how many times a day; satisfied after stool; urgency; straining even if soft?
Urine: any problem; smell; flow slow to start, interrupted, feeble or dribbling?
Perspiration: how much; which part most; smell; staining and colour; palms and soles?
Sleep: position; pattern; grinding, snoring, talking, starting from sleep; covering or uncovering?
Abnormal discharges, if any
Ailments from suppression of discharges (menses, sweat, leucorrhoea, catarrh, eruptions, etc.)
Age at menarche; cycle regular or irregular; length of cycle
Flow: duration, quantity, colour, smell, staining
Complaints before, during or after menses
Menopause: age and complaints
Leucorrhoea: nature, colour, consistency, smell; relation to menses; itching or burning
Pregnancies, deliveries, abortions; any trouble with breasts
Desire increased or decreased; aversion
Feelings or symptoms before, during or after intercourse
Erection or ejaculation complaints; seminal emissions (men)
Dryness, pain or bleeding with intercourse (women)
Sexually transmitted or recurrent genital infections
Contraception
Memory: poor for what, and at what time? Comprehension and concentration?
How has the disposition changed during sickness? Mild, irritable, obstinate, gloomy, cheerful?
Anxiety or apprehension about the future; fears (of people, animals, things)
Company or solitude; reaction to consolation; easily offended
Weeping or laughing easily; jealousy; indifference; indecision
Delusions: imagines things that have no existence
Three wishes
Willingness to change (high / moderate / low)
Dreams: circle the types the patient has.
Appearance, build, nutrition, anaemia, jaundice, cyanosis, oedema, clubbing, nails, glands, pulse, BP, temperature, respiration, weight, moles, warts, pigmentation, tongue.
Alimentary, respiratory, cardiovascular, uro-genital, locomotor, nervous system, skin and mucous membranes.
Common and uncommon; mental generals, physical generals, particulars.
Grade the symptoms; mark the strange, rare and peculiar.
Miasmatic diagnosis: Psora / Sycosis / Syphilis / Psora + Sycosis / Psora + Syphilis / Psora + Sycosis + Syphilis
With repertory and page number.
After consultation of the materia medica, with reasons.
Add each visit; do not rewrite earlier entries.
| Date | Changes (better / worse / same / new / resolved) | Treatment response (−4 to +4) | Prescription |
|---|---|---|---|
Patient details; present complaints as narrated by the patient; each complaint in detail as a Complete Symptom (Location, Sensation, Modalities); concomitants; history of present illness and causation; past, family and personal history; physical and mental generals; clinical examination; provisional diagnosis, investigations and confirmed diagnosis; analysis and evaluation; miasmatic analysis; totality; rubrics and repertorisation; final selection of medicine; follow-up.
A symptom described by its Location, Sensation and Modalities. Concomitants and causation are recorded separately rather than as extra parts of the symptom.
Complaints that appear along with the main complaint but are not part of it, for example profuse urination with a headache or thirstlessness during fever. They are often characteristic and are recorded as their own category.
Yes. Print it or save it as a PDF from this page and use it in your clinic or college.
Yes. HomeoNetix follows this structure on screen, keeps every follow-up as an amendment, and adds a repertory, materia medica and AI-assisted analysis. Book a free demo to see it.
✓ Free guided demo ✓ Onboarding in a day ✓ Made in India