Section

Questions reflecting to

Male

Female

Physical symptoms

A

Eyes and ears

10

10

B

Respiratory system

21

21

C

Cardiovasucular system

14

14

D

Digestive tract

28

28

E

Musculoskelectal system

10

10

F

Skin

9

9

G

Nervous system

19

19

H

Genitourinary system

11

13

I

Fatigability

7

7

J

Frequency of illness

9

9

K

Miscellaneous disease

15

15

L

Habits

7

7

Total

160

162

Mental symptoms

M

Mood and feeling patterns

12

12

N

Inadequacy

6

6

O

Depression

9

9

P

Anxiety

6

6

Q

Sensitivity

9

9

R

Anger

9

9

Total

51

51