BSN Tracker

Clinical Framework: Review of Systems (ROS)

The Review of Systems is a systematic verbal inquiry covering all major body systems for abnormal symptoms. It is conducted as part of the comprehensive health history, after the chief complaint and history of present illness are established. The ROS identifies symptoms the patient may not have volunteered and uncovers problems unrelated to the presenting concern, helping to prioritize and guide the physical examination. For each system, mark Negative (–) if the patient denies all relevant symptoms, Positive (+) if any symptoms are reported (then describe them), or Not Asked if the system was not reviewed during this encounter. A thorough ROS typically covers 10 or more systems.

Review of Systems (ROS)

The Review of Systems is a systematic head-to-toe inventory of symptoms across all body systems. It is obtained verbally during the health history and is distinct from the physical examination. The ROS identifies symptoms the patient may not have volunteered, uncovers problems unrelated to the chief complaint, and guides the physical examination priorities. Document each system as Negative (no symptoms), Positive (symptoms present), or Not Asked.

Documentation guide

Negative (–) Patient denies all symptoms in this system
Positive (+) Patient reports one or more symptoms — describe below
Not Asked System not reviewed during this encounter

General / Constitutional

Fever, chills, fatigue, unexplained weight loss or gain, night sweats, malaise

HEENT (Head, Eyes, Ears, Nose, Throat)

Headache, vision changes, diplopia, eye pain/redness, hearing loss, tinnitus, ear pain/discharge, nasal congestion, epistaxis, sore throat, hoarseness, dental pain

Neck

Neck pain, stiffness, lumps, lymphadenopathy, difficulty swallowing

Respiratory

Cough (productive/dry), dyspnea, wheezing, hemoptysis, pleuritic chest pain

Cardiovascular

Chest pain or pressure, palpitations, syncope, pre-syncope, orthopnea, PND, lower extremity edema, claudication

Gastrointestinal

Nausea, vomiting, dysphagia, heartburn, abdominal pain, bloating, diarrhea, constipation, melena, hematochezia, jaundice

Genitourinary

Dysuria, frequency, urgency, hematuria, nocturia, incontinence, flank pain, discharge, last menstrual period (if applicable), dysmenorrhea

Musculoskeletal

Joint pain, swelling, stiffness, limited range of motion, muscle aches, back pain, gait changes

Neurological

Dizziness, vertigo, syncope, seizures, weakness, sensory changes, numbness/tingling, tremor, coordination problems, memory loss, speech difficulties

Psychiatric / Mental Status

Anxiety, depression, mood changes, sleep disturbances, hallucinations, suicidal/homicidal ideation, memory or concentration problems

Integumentary (Skin, Hair, Nails)

Rash, pruritus, lesions, changes in moles, hair loss, nail changes, wounds, poor healing

Endocrine

Polydipsia, polyuria, heat or cold intolerance, excessive sweating, thyroid enlargement, growth changes

Hematologic / Lymphatic

Easy bruising, prolonged bleeding, lymph node enlargement, recurrent infections, anemia symptoms (fatigue, pallor)

Immunologic / Allergic

Known allergies, allergic reactions, recurrent or unusual infections, autoimmune conditions