Review of systems - E & M Basic

Review of Systems

ROS is an inventory of body systems obtained by asking a series of questions in order to identify signs and/or symptoms that the patient may be experiencing or has experienced. The following systems are recognized for ROS purposes:

** Constitutional Symptoms (for example, fever, weight loss);

** Eyes;

** Ears, Nose, Mouth, Throat;

** Cardiovascular;

** Respiratory;

** Gastrointestinal;

** Genitourinary;

** Musculoskeletal;

** Integumentary (skin and/or breast);

** Neurological;

** Psychiatric;

** Endocrine;

** Hematologic/Lymphatic; and

** Allergic/Immunologic.

There are three types of ROS: problem pertinent, extended, and complete.

A problem pertinent ROS inquires about the system directly related to the problem identified in the HPI.

In the following example, one system – the ear – is reviewed:

** CC: Earache.

** ROS: Positive for left ear pain. Denies dizziness, tinnitus, fullness, or headache.


An extended ROS inquires about the system directly related to the problem(s) identified in the HPI and a limited number (two to nine) of additional systems.

In the following example, two systems – cardiovascular and respiratory – are reviewed:

** CC: Follow up visit in office after cardiac catheterization. Patient states “I feel great.”

** ROS: Patient states he feels great and denies chest pain, syncope, palpitations, and shortness of breath. Relates occasional unilateral, asymptomatic edema of left leg.

A complete ROS inquires about the system(s) directly related to the problem(s) identified in the HPI plus all additional (minimum of ten) organ systems. Those systems with positive or pertinent negative responses must be individually documented. For the remaining systems, a notation indicating all other systems are negative is permissible. In the absence of such a notation, at least ten systems must be individually documented.


 In the following example, ten signs and symptoms are reviewed:

** CC: Patient complains of “fainting spell.”

** ROS:

• Constitutional: Weight stable, + fatigue.

• Eyes: + loss of peripheral vision.

• Ear, Nose, Mouth, Throat: No complaints.

• Cardiovascular: + palpitations; denies chest pain; denies calf pain, pressure, or edema.

• Respiratory: + shortness of breath on exertion.

• Gastrointestinal: Appetite good, denies heartburn and indigestion.

+ episodes of nausea. Bowel movement daily; denies constipation or loose stools.

• Urinary: Denies incontinence, frequency, urgency, nocturia, pain, or discomfort.

• Skin: + clammy, moist skin.

• Neurological: + fainting; denies numbness, tingling, and tremors.

• Psychiatric: Denies memory loss or depression. Mood pleasant.