Rheumatology Intake Form

The Rheumatology Intake Form is purpose-built for rheumatology practices, capturing the detailed musculoskeletal and autoimmune symptom history that rheumatologists need for accurate diagnosis and treatment planning. This template collects patient demographics alongside a comprehensive joint assessment covering pain location (using a body map approach), swelling, stiffness (duration and morning pattern), redness, warmth, decreased range of motion, and joint deformity. The structured symptom timeline distinguishes inflammatory from non-inflammatory patterns, acute from chronic presentations, and symmetric from asymmetric involvement.

Designed for general rheumatology, inflammatory arthritis, lupus, vasculitis, and connective tissue disease practices, this form includes sections for systemic autoimmune symptoms (rash, photosensitivity, oral ulcers, dry eyes and mouth, Raynaud phenomenon, hair loss, fatigue, fever), prior rheumatologic testing (RF, anti-CCP, ANA, ESR, CRP, complement levels), imaging history (X-rays, MRI, ultrasound), and a thorough medication history covering NSAIDs, DMARDs, biologics, JAK inhibitors, and corticosteroids. The functional assessment section captures the impact of rheumatic disease on daily activities, work capacity, and quality of life.

All fields are HIPAA-compliant and optimized for the rheumatology evaluation workflow. Patients document their joint symptoms, systemic features, and prior workup before the consultation, allowing the rheumatologist to identify patterns suggestive of specific diagnoses and plan the physical examination accordingly. The structured format reduces the time spent on history-taking and ensures that critical autoimmune features are systematically screened.