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DR
Dr. Smith
Personal Information
Full Name
Date of Birth
Gender
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Male
Female
Other
Phone
Email
Aadhaar / ID
Address
Ayurvedic Assessment
Prakriti (Body Constitution)
Vata Prakriti
Pitta Prakriti
Kapha Prakriti
Vata-Pitta
Pitta-Kapha
Vata-Kapha
Sama Prakriti
Vikriti (Current Imbalance)
Dominant Dosha
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Vata
Pitta
Kapha
Vata-Pitta
Pitta-Kapha
Vata-Kapha
Tridosha
Dhatu Affection
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Rasa
Rakta
Mamsa
Meda
Asthi
Majja
Shukra
Agni Type
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Samagni
Mandagni
Tikshnagni
Vishamagni
Nadi Pariksha (Pulse Examination)
Vata Nadi
Normal
High
Low
Absent
Pitta Nadi
Normal
High
Low
Absent
Kapha Nadi
Normal
High
Low
Absent
Heart Rate (bpm)
Ashtavidha Pariksha (8-fold Examination)
Jihva (Tongue)
Drika (Eyes)
Sparsha (Touch / Skin)
Akriti (General Build)
Shabda (Voice)
Mutra (Urine)
Presenting Complaints & History
Chief Complaint
History of Present Illness
Past Medical History
Family History
Allergies
Lifestyle Assessment
Diet Type
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Vegetarian
Non-Vegetarian
Sattvic
Mixed
Bowel Habits
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Regular
Constipation
Loose
Irregular
Sleep Pattern
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Sound
Disturbed
Insomnia
Excessive
Appetite
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Good
Poor
Excessive
Variable
Stress Level
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Low
Moderate
High
Severe
Exercise
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Regular
Occasional
Sedentary
Yoga/Pranayama
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