History of Present Illness (HPI): Comprehensive Guide with Examples and Template

The history of present illness (HPI) is one of the most critical elements of patient documentation, serving as the bridge between a patient’s chief complaint and the broader context of their medical history. Unlike other components of a clinical record that focus on past encounters or general background, the HPI captures the patient’s current condition in detail, documenting the sequence of events, associated symptoms, and contributing factors that shape the diagnostic process.

At its core, the HPI is not simply a list of complaints—it is a structured narrative that translates a patient’s description of illness into a format that clinicians can use to guide evaluation, testing, and treatment. This level of detail ensures that providers do not overlook important information, whether it involves the onset and progression of chest pain, the aggravating and relieving factors associated with shortness of breath, or the presence of relevant risk factors in chronic conditions.

For nursing students and healthcare trainees, learning to construct an effective HPI is both a technical skill and a professional responsibility. A well-written HPI communicates essential patient information clearly and logically, supports the development of a working diagnosis, and enhances collaboration across the healthcare team. Without it, clinicians risk gaps in documentation, miscommunication, and even diagnostic errors.

By adopting a structured format and relying on practical tools such as standardized templates or methods like OLD CARTS and PQRST, practitioners can ensure that each patient encounter is documented thoroughly and consistently. Beyond its role in clinical documentation, the HPI also reinforces critical thinking, guiding students to ask the right questions, organize data effectively, and uncover details that might otherwise remain hidden.

Ultimately, the history of present illness represents more than a chart entry—it is a cornerstone of patient care. Through precise description, careful documentation, and logical organization, the HPI transforms a patient’s story into a clinical foundation upon which safe, comprehensive, and evidence-based care is built.

What is History of Present Illness (HPI)?

The history of present illness is a focused, chronological narrative that explains how the current problem started, how it evolved, and what influences it. In standard teaching and billing guidance, the write-up describes the progression “from the first sign or symptom to the present,” typically including location, quality, severity, duration, timing, context, modifying influences, and associated symptoms. This structure turns a one-line chief complaint into a decision-ready account that supports diagnostic reasoning and care planning. 

Two widely taught frameworks help you collect and organize this story:

OLD CARTS — Onset, Location (and radiation), Duration, Character, Aggravating factors, Relieving factors, Timing (frequency/pattern), Severity. Use it for any symptomatic concern (not just pain). Example prompts:
• Onset: “When did it begin? What were you doing?”
• Location/radiation: “Where is it? Does it travel anywhere?”
• Duration: “How long does each episode last?”
• Character: “What does it feel like—pressure, burning, stabbing?”
• Aggravating/Relieving: “What makes it worse? What eases it?”
• Timing: “Is it constant or intermittent? Any pattern during the day?”
• Severity: “How bad is it on a scale of 1 to 10 at its worst?”
These elements ensure a thorough yet concise account that can be read quickly by the next clinician.

PQRST (±U) — Provocation/Palliation (what triggers/relieves it), Quality (what it feels like), Region/Radiation, Severity (numeric rating), Timing (onset, frequency, pattern). Many nursing texts add U (Understand/You): “What do you think is happening and how does it affect you?” PQRST is especially useful for pain but adapts to dyspnea, dizziness, or other symptom clusters. Example prompts:
• P: “What brings it on? What have you tried that helps?”
• Q: “Is it dull, sharp, heaviness, tightness?”
• R: “Point to the exact spot; does it spread?”
• S: “Rate it from 0–10.”
• T: “When did it start? Is it better/worse at certain times?”
• U: “What worries you most about this problem?” 

Mini-example (one paragraph HPI, exertional pressure):
“Three-day history of intermittent retrosternal pressure (character) that begins after climbing one flight of stairs (provocation/timing) and eases within 5 minutes of rest (palliation/relieving). Peak severity 6/10; no prior episodes; denies cough or fever; reports nausea and mild shortness of breath (associated symptoms). Smokes 10 pack-years (contextual risk factors).”
Note how OLD CARTS and PQRST map onto the same core elements. Guidance from professional societies then directs subsequent evaluation.

Why is HPI important in medical practice?

The history of present illness (HPI) plays a central role in clinical reasoning. It transforms the chief complaint (CC) into a structured description that allows healthcare providers to understand not only what the patient is experiencing but also how the problem developed, what influences it, and what risks may be involved. Unlike isolated notes, a well-crafted HPI serves as a critical anchor for the entire diagnostic process.

1. Guiding Diagnostic Accuracy
   Studies have repeatedly shown that the majority of correct diagnoses come primarily from the history rather than from lab tests or imaging. The HPI helps clinicians uncover the underlying condition, clarifies whether symptoms are acute or chronic, and directs which diagnostic steps should follow. For instance, documenting onset, severity, and progression of chest pain can help distinguish between myocardial ischemia and gastrointestinal reflux.
2. Reducing Errors and Miscommunication
   A poorly written HPI can lead to misinterpretation, missed risk factors, or inappropriate testing. For example, failing to note that pressure-like sensation occurs after exertion and is relieved by rest may cause providers to overlook angina. Proper documentation ensures accurate communication between nurses, physicians, and other healthcare providers, reducing the risk of error.
3. Improving Patient Care and Outcomes
   Beyond diagnosis, the HPI reflects the patient’s current illness in a way that promotes continuity of care. When shift changes occur or when multiple clinicians are involved, the HPI provides a concise but comprehensive narrative that informs ongoing management. For example, describing a person’s shortness of breath in terms of triggers, relieving factors, and impact on function helps the team tailor both acute and long-term management.

How does HPI differ from other components of a patient history?

Although the HPI is part of the overall medical history, it serves a distinct function compared to other sections:

1. Chief Complaint (CC)
   • The CC is a brief statement in the patient’s own words (“I have crushing pressure in my chest”).
   • The HPI takes that one line and expands it into a detailed, structured narrative, explaining the timing, duration, triggers, and associated symptoms.
     Example: CC: “Trouble breathing.” → HPI: “The patient reports sudden onset of severe shortness of breath two hours ago, following light activity. Severity 7/10, worsened by exertion (aggravate) and eased by sitting upright (relieving factors).”
2. Past Medical History (PMH)
   • PMH records chronic illnesses, surgeries, allergies, and medications.
   • HPI focuses only on the patient’s current illness, though prior medical history may be referenced if it influences the present complaint.
     Example: Past history of asthma may be noted in the HPI if the current complaint is wheezing.
3. Review of Systems (ROS)
   • The ROS is a tool for systematically screening each body system for other complaints.
   • The HPI instead targets the current encounter, integrating only relevant positives and negatives.
     Example: In a patient with chest pain, the HPI includes “no palpitations, no syncope,” while the ROS might separately check for headaches, abdominal pain, or urinary issues.

In summary, the HPI is unique because it focuses on the patient’s current illness, provides a chronological account, and ties symptoms directly to a working diagnosis—while other history components provide supporting context.

What are the key components of a well-structured HPI?

A well-structured HPI follows a logical, structured format that ensures no essential detail is missed. Most educators and clinical guidelines highlight eight key elements:

1. Location – Where is the problem?
   Example: “Pain located in the mid-sternum, radiating to the left arm.”
2. Quality/Character – What does it feel like?
   Example: “Described as a heavy, pressure-like sensation rather than sharp pain.”
3. Severity – How bad is it?
   Example: “Rates pain 8/10 on a scale of 1 to 10.”
4. Timing – When did it begin and what is the pattern?
   Example: “Pain began suddenly yesterday; occurs daily after climbing stairs.”
5. Duration – How long has the problem persisted?
   Example: “Each episode lasts approximately 10 minutes.”
6. Context – What was happening when it started?
   Example: “Pain started while mowing the lawn; no history of trauma.”
7. Modifying Factors – What makes it better or worse?
   Example: “Pain aggravated by exertion, relieved by nitroglycerin.”
8. Associated Symptoms – What other issues accompany it?
   Example: “Nausea, diaphoresis, and shortness of breath accompany episodes.”

Mnemonics for Structure

• OLD CARTS (Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity) provides a checklist to ensure every element is captured.
• PQRST (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing, ± Understanding) emphasizes provoking/relieving factors and adds the patient’s perception of illness.

Applied Example (Chest Pain HPI):
“52-year-old male with sudden onset of substernal pressure (location/quality) radiating to the jaw (radiation). Each episode lasts 20 minutes (duration) and occurs at rest (timing/context). Rated 9/10 in severity. Pain aggravated by exertion and partially relieved by rest (modifying factors). Associated diaphoresis and shortness of breath noted. Hypertension and smoking are risk factors. Concern for myocardial ischemia.”

This example illustrates how the eight key elements combined with OLD CARTS or PQRST create a comprehensive yet concise account that supports evaluation, reduces the chance to overlook details, and informs a working diagnosis.

How to Write an Effective HPI?

A strong HPI converts the chief complaint (CC) into a clear, chronological description of the current condition that another clinician can act on immediately. Start with one line that restates the CC with onset and context (e.g., “48-year-old with 2 days of exertional chest pressure”), then build the narrative using a structured format (OLD CARTS or PQRST). Include only relevant facts that drive evaluation, and keep sentences concise but specific. Classic key elements are location, quality, severity, timing, duration, context, modifying influences (what aggravates or helps), and associated symptoms. Brief vs extended HPIs are defined by how many of these elements you include. 

Step-by-step

1. Set the scene. Who is the patient (age/sex when needed), what is the CC, and when did it begin?
2. Chronology. Describe the progression from first symptom to present—what changed, and when.
3. OLD CARTS or PQRST. Use one framework consistently (see below).
4. Pertinent risks. Add risk factors or exposures that meaningfully shape possible diagnoses (e.g., smoking, diabetes).
5. Pertinent negatives. Name key features you intentionally checked and did not find (e.g., “no pleuritic pain, no fever”).
6. Impact & interpretation. If helpful, add functional impact or the person’s concern in one line (e.g., “stops walking after one block”).

Example (tight, exertional pressure)
“48-year-old with 2 days of central pressure beginning with stair-climbing (onset/context), described as heavy ‘crush-like’ sensation (quality) radiating to the left arm (location/radiation), peaking at 7/10 (scale of 1 to 10) and lasting ~10 minutes per episode (duration). Worse with exertion, eased by rest (relieving factors). Nausea and shortness of breath present; no cough or fever (associated symptoms/negatives). Hypertension and 15 pack-years (risk factors). Concern for cardiac ischemia.”
This organization mirrors guideline-driven chest-pain triage and supports a rapid working diagnosis before testing.

What questions should you ask to gather HPI information?

Use one tool consistently so your gathering is efficient and thorough:

OLD CARTS — Onset, Location (± radiation), Duration, Character, Aggravating, Relieving, Timing/pattern, Severity

• Prompts: “When did it start?” “Point to where it is; does it travel?” “How long does an episode last?” “What does it feel like (pressure, burning)?” “What brings it on?” “What helps?” “Constant or intermittent?” “How bad at its worst?” 

PQRST (±U) — Provocation/Palliation, Quality, Region/Radiation, Severity, Timing (± Understanding/impact)

• Prompts: “What triggers or eases it?” “What does it feel like?” “Where is it—does it move?” “Rate it 0–10.” “When did it begin; any pattern?” “What do you think is going on?” Although taught for pain, it adapts to dyspnea, dizziness, or fatigue. 

Condition-focused examples

• Chest pain: Ask exertional vs rest pattern, radiation to jaw/arm/back, diaphoresis, nausea, and relief with rest or nitroglycerin; these answers steer ACS risk. 
• Abdominal pain: Meals, bowel changes, GI bleeding, NSAID use (context). 
• Dyspnea: Orthopnea, exertional threshold, wheeze vs chest tightness, viral prodrome (pertinent negatives).

How should you organize the information for clarity?

Think “top-down and logical”:

1. Lead sentence: CC + onset + context.
2. Chronology paragraph: one tight paragraph using OLD CARTS/PQRST; weave in associated symptoms and key negatives instead of listing them later.
3. Risks & relevant past: Fold only what truly informs the current condition (e.g., hyperlipidemia, smoking). Avoid duplicating the medical history.
4. Selective ROS: Add a few select positives/negatives that materially narrow the field; keep the full review of systems in its own section.
5. Close with impact: One line on function or concern can sharpen assessment and next steps.

When to use a template. A simple HPI template (or “diagnostic history of present illness template”) can standardize data capture and make your note more customizable and efficient. Treat it as a checklist, not a script—tailor entries to the encounter so you truly communicate what happened. 

Formatting tips

• Prefer full sentences over fragments when nuance matters; bullets are acceptable for fast emergency updates.
• Keep units and scales consistent; avoid ambiguous time words (“recently”)—use exact hours/days.
• If the story is complex (e.g., chronic problems), use headings (“Early course,” “Last 48 h”) to ensure clarity.
• Always align descriptors with guideline language for priority syndromes like chest pain.

What should you avoid when writing an HPI?

• Vagueness. “Painful chest” is unhelpful; describe quality and timing precisely (e.g., “pressure, 10–15 min after exertion”). 
• Mixing sections. Don’t paste a long ROS into the HPI. Keep HPI focused on the patient’s current illness and move the rest to ROS/PMH. 
• Diagnosis instead of data. Write findings, not conclusions (“pressure with exertion, eased by rest”), and let the working diagnosis follow in the assessment. 
• Template overreach. Copy-pasted phrases that don’t match the story create error and mislead healthcare providers—edit boilerplate every time. 
• Forgetting risks. Omitting risk factors (e.g., smoking) or key negatives can cause you to overlook emergent medicine pathways (e.g., suspected myocardial ischemia). Leading questions. Avoid steering answers (“It’s heartburn, right?”). Use open probes, then clarify.
• Inconsistent scales. If you record severity, stick to the same numeric tool across notes.
• Poor handoff value. If another provider can’t reconstruct the story from your HPI, it isn’t ready to document. Aim for a comprehensive yet practical narrative that helps avoid medical errors and supports timely communication and care decisions

Common Formats for HPI Documentation

Clinical teams use several standard formats to record the history of present illness (HPI). Each format has strengths and trade-offs: the narrative form preserves nuance; the SOAP note integrates HPI into a broader clinical entry; and PQRST is a symptom-focused method that helps standardize how we elicit and record pain or other prominent complaints. Below we explain each approach, show how to apply it, and give practical examples and tips for students.

What is the Narrative Format and when should it be used?

What it is:
A narrative HPI is a short, continuous paragraph (or a few short paragraphs) that tells the story of the patient’s current problem from onset to the present. It reads like a concise clinical story: age/sex (when relevant), chief complaint in the person’s own words, chronology (how it began and progressed), modifying factors, associated features, and key negatives.

When to use it:

• When the presentation is complex (multiple symptoms, fluctuating course).
• In outpatient notes or inpatient history and physicals where nuance and context matter.
• When an encounter requires a readable, interpretive account that other clinicians will review (e.g., handoffs, consults).

How to structure it:

1. Lead sentence: one line with age/sex and the problem with onset.
2. Chronology: how symptoms evolved, using OLD CARTS/PQRST elements implicitly.
3. Modifiers and associated features: what worsens/helps, other symptoms, functional impact.
4. Background: brief, only if directly relevant (risk factors, recent meds, prior episodes).
5. Close: one sentence about current status or clinical concern.

Advantages:

• Preserves patient voice and nuance.
• Easy for other clinicians to read and interpret context.
• Flexible for complex stories.

Drawbacks:

• Can become wordy or unfocused without discipline.
• More variability between writers—risk of omitting an element unless you use a mental checklist.

Example (narrative HPI — chest pain):
“54-year-old male reports sudden onset of substernal pressure three hours ago while gardening. He describes the pain as a heavy, squeezing sensation that radiates to the left jaw and arm, lasting about 20 minutes per episode and recurring twice since onset. Pain peaks at 8/10, is worse with exertion and somewhat relieved by rest. Associated diaphoresis and mild nausea; denies cough or fever. History notable for hypertension and a 20 pack-year smoking history. Concern for cardiac ischemia.”

Tips for students:

• Keep sentences short and focused; avoid long lists that read like a ROS.
• Use exact times/dates rather than “recently.”
• Insert brief, relevant negatives that change management (e.g., “no pleuritic pain” in chest pain).

How does the SOAP format structure the HPI?

What SOAP is:
SOAP is a universal structure for medical notes: Subjective, Objective, Assessment, Plan. The HPI belongs in the Subjective section and serves as the lead narrative that sets up the problem the rest of the note will address.

How the HPI appears in SOAP:

• S (Subjective): chief complaint (verbatim shorter phrase), followed by the HPI paragraph (narrative or bulleted OLD CARTS/PQRST answers), relevant past medical history, current medications, and brief ROS items that are pertinent to the presenting complaint.
• O (Objective): vitals, focused physical exam findings, bedside tests (ECG, glucose), and measurable data.
• A (Assessment): succinct problem list and working diagnosis(es) derived from the HPI + objective data.
• P (Plan): diagnostics, treatments, monitoring, and patient education.

Why SOAP helps:

• Standardizes documentation for teams and supports billing requirements.
• Forces separation of subjective information (what the patient reports) from objective signs and data.
• Makes it straightforward to convert the HPI into an assessment and plan.

Example (SOAP note with HPI as Subjective):
S: “CC: ‘Severe chest pressure’ — 54-year-old male with sudden substernal pressure 3 hours ago while gardening. Heavy, radiating to left jaw/arm, 8/10, lasts ~20 minutes; associated diaphoresis and nausea; relieved partly by rest. HTN; 20 pack-yr smoker.”
O: BP 150/92, HR 102, RR 18, SpO₂ 98% on room air. Heart regular; lungs clear; ECG shows nonspecific ST-T changes.
A: Acute chest pain — ischemic chest pain vs nonischemic; rule out acute coronary syndrome.
P: Stat troponin, serial ECGs, aspirin 325 mg chewable, cardiology consult, monitor.

Practical advice:

• Put a crisp HPI under Subjective; don’t bury important time/trigger details in Objective.
• Use SOAP in fast-paced settings (ED, inpatient) where the team needs quick clarity.

What is the use of the PQRST method in HPI documentation?

What PQRST is:
PQRST is a focused mnemonic that guides how to ask about and record a main symptom (especially pain). Each letter prompts a clinically useful probe:

• P — Provocation / Palliation: What causes or triggers it? What relieves it? (e.g., exertion vs rest, antacids, position)
• Q — Quality: What does it feel like? (sharp, dull, burning, crushing)
• R — Region / Radiation: Where is it? Does it move or spread?
• S — Severity: How bad is it? Use a numeric scale (0–10) and ask about peak and baseline.
• T — Timing: When did it start? Is it constant or intermittent? Any pattern?

(You may add U — Understanding/Impact to capture the patient’s perception or how the symptom limits activities.)

How to use PQRST in HPI writing:

• Use PQRST as a clinician’s checklist during the interview. Then translate the answers into a narrative or bullet format in the chart.
• For pain syndromes, PQRST ensures you don’t miss provocation/palliation and accurate severity measurement, both of which change management.
• When documenting, place patient quotes for quality or provoking events in quotation marks to preserve voice (e.g., “crushing” or “like a band around my chest”).

Example (PQRST applied to chest pain):

• P (Provocation/Palliation): Began while climbing stairs; eased by rest.
• Q (Quality): Heavy, “crushing” pressure.
• R (Region/Radiation): Substernal, radiates to left arm and jaw.
• S (Severity): 8/10 at peak.
• T (Timing): Began 3 hours ago; episodes last ~20 minutes and recur.

Converting to HPI (narrative using PQRST):
“54-year-old male with substernal crushing pressure that began 3 hours ago while climbing stairs (provocation). Pain radiates to the left arm and jaw (region) and peaks at 8/10 (severity), lasting ~20 minutes per episode (timing). Pain eases with rest (palliation). Associated diaphoresis and nausea.”

When PQRST is especially useful:

• Pain complaints (chest, abdominal, musculoskeletal).
• Any dominant symptom where details of provocation and severity directly change triage or therapy (e.g., shortness of breath, severe headache).

Pitfalls to avoid with PQRST:

• Stopping at “quality” without asking about timing or severity.
• Documenting a checklist mechanically without creating a coherent story—always translate the checklist into a readable HPI line or paragraph.
• Using PQRST alone when the problem requires a broader chronology (for complex, fluctuating, or multi-system problems).

Examples of HPI Documentation

When learning how to write a history of present illness (HPI), students often find it helpful to look at real-world examples. Good examples illustrate not just the patient’s symptoms but also the clarity, organization, and clinical reasoning behind the note. Below we go step by step through sample HPI entries for common conditions, explain how to tailor documentation for specific demographics, and highlight what makes an HPI example stand out in professional practice.

What are some sample HPI entries for common conditions?

Different complaints require slightly different emphasis, but the foundation always includes chronology, symptom characteristics (often using OLD CARTS or PQRST), modifiers, associated features, and key negatives.

Example 1: Chest Pain (Adult, Emergency Setting)

Chief Complaint (CC): “Crushing chest pain”

HPI:
Mr. J is a 58-year-old male presenting with sudden onset of substernal chest pressure that began while mowing the lawn 45 minutes ago. He describes the pain as a “crushing, heavy” sensation (Quality), 9/10 in intensity (Severity), radiating to the left arm and jaw (Region/Radiation). Pain worsens with exertion and improves slightly with rest (Provocation/Palliation). Each episode lasts about 20 minutes (Timing). Associated symptoms include diaphoresis, nausea, and shortness of breath. He denies fever, cough, palpitations, or pleuritic chest pain (Pertinent negatives). History is significant for hypertension and hyperlipidemia; 20 pack-year smoking history.

👉 This HPI stands out because it uses PQRST, includes relevant negatives, and ties in risk factors that guide differential diagnosis (e.g., ACS vs GERD vs musculoskeletal pain).

Example 2: Abdominal Pain (Adult, Primary Care Setting)

CC: “Stomach hurts after meals”

HPI:
Ms. K is a 34-year-old female with a 2-week history of epigastric burning discomfort that occurs 30–60 minutes after meals (Timing). Pain is described as “gnawing” (Quality), 6/10 in intensity (Severity), worsened by spicy foods and coffee (Provocation) and partially relieved by antacids (Palliation). No radiation of pain (Region). Associated nausea but no vomiting, melena, hematemesis, or weight loss. No recent travel, antibiotic use, or sick contacts.

👉 This example highlights OLD CARTS and key negatives that help rule out serious conditions like GI bleeding or infection, while pointing toward peptic ulcer disease or GERD.

Example 3: Pediatric Fever (Parent Report, Clinic Setting)

CC: “Fever and fussiness”

HPI:
Tommy is a 2-year-old male whose mother reports fever (Tmax 39.5°C) beginning 24 hours ago. Onset was sudden (Onset) with associated irritability, decreased appetite, and tugging at the right ear. No vomiting, diarrhea, cough, or rash. Mother gave acetaminophen with partial relief (Treatment/Palliation). He has had normal urine output and no sick contacts.

👉 This HPI demonstrates adaptation for pediatrics: history comes from the caregiver, and functional details (feeding, urination, behavior) replace symptom descriptions the child cannot give.

Example 4: Geriatric Fall (Emergency Setting)

CC: “Fell this morning”

HPI:
Mrs. L is an 82-year-old female who tripped on a rug at home and fell onto her right hip at 9:00 AM today. She immediately experienced sharp pain in the right hip (Quality), now 8/10 (Severity), worsened by movement and unable to bear weight (Palliation/Provocation). No loss of consciousness, dizziness, chest pain, or palpitations before the fall (Pertinent negatives). She has a history of osteoporosis and takes alendronate.

👉 This example emphasizes timing and mechanism of injury, functional limitations, and pertinent negatives (to exclude syncope or cardiac cause).

How can you tailor HPI examples to specific patient demographics?

An effective HPI always considers the patient’s demographic context, because age, gender, and background shape both how symptoms are reported and how clinicians interpret them.

• Pediatrics: Symptoms may be observed behaviors reported by parents. Include details about feeding, play, irritability, and diaper output.
  Example: “Infant less interested in feeding, only finishing half bottles, pulling at ears.”
• Adolescents: May minimize symptoms or feel embarrassed; include social context (sports, sexual history, substance use if relevant).
  Example: “16-year-old athlete with knee pain after soccer practice, denies locking but reports swelling after exertion.”
• Adults: Often give detailed descriptors; documentation should highlight risk factors (occupation, smoking, comorbidities).
  Example: “Truck driver with 20 pack-year history reports chronic cough, sputum production.”
• Geriatrics: Important to document functional impact (mobility, ADLs), medication use, and cognitive status.
  Example: “Difficulty remembering medication schedule, reports multiple recent falls.”
• Cultural/linguistic considerations: Always document the patient’s own words when possible, especially descriptors like “burning” or “pressure,” and note if interpretation was used.

What makes a good HPI example stand out?

• Clarity and organization
  • Presents information in a logical order: onset, chronology, modifiers, associated features, pertinent negatives.
  • Avoids clutter from unrelated details.
• Use of structured tools (OLD CARTS, PQRST)
  • Ensures nothing is missed.
  • Converts checklist answers into a smooth narrative.
• Patient-centered language
  • Includes the patient’s own words for the chief complaint.
  • Avoids medical jargon when quoting patients.
• Pertinent negatives and risk factors
  • Shows the clinician thought about the differential.
  • Example: Chest pain with “no pleuritic pain, no cough, no fever” rules out pneumonia or PE.
• Demographic tailoring
  • Adjusts to age, developmental stage, and functional status.
  • Example: Pediatric HPIs emphasize caregiver report; geriatric HPIs include fall risk and independence.
• Relevance to clinical reasoning
  • Every detail points toward or away from a likely diagnosis.
  • Strong examples anticipate the assessment section of a SOAP note.

Template for Writing HPI

A history of present illness (HPI) template provides a structured way to collect, organize, and document patient information. For nursing students and other healthcare trainees, a good template ensures that no critical details are missed and that the documentation is clear, concise, and clinically useful. Below, we’ll look at the essential elements of an HPI template, how it can be customized for different specialties, and the role of technology in shaping modern HPI documentation.

What are the essential elements of an HPI template?

An effective HPI template organizes the narrative into a logical flow that answers key clinical questions. The most widely used elements include:

1. Patient Demographics
   • Age, gender, and relevant identifiers (e.g., “45-year-old female”).
   • Provides context, since symptoms often vary with age and sex.
     Example: Chest pain in a 25-year-old female on oral contraceptives raises concern for pulmonary embolism, while in a 65-year-old male smoker it raises suspicion for myocardial infarction.
2. Chief Complaint (CC)
   • The patient’s main symptom(s) stated in their own words, in quotation marks when possible.
     Example: “I have this crushing chest pain.”
3. Onset
   • When the symptom started and how (sudden vs gradual).
     Example: “Pain began suddenly while climbing stairs 2 hours ago.”
4. Location and Radiation
   • Exact site and whether it spreads elsewhere.
     Example: “Sharp pain in the right lower abdomen radiating to the groin.”
5. Duration and Timing
   • How long the symptom lasts, frequency, and pattern (constant vs intermittent).
     Example: “Headaches last about 30 minutes, occurring 3–4 times per week, mostly in the evenings.”
6. Character/Quality of Symptom
   • Descriptive adjectives like burning, throbbing, stabbing, or pressure.
     Example: “Burning sensation in the chest, like acid rising up.”
7. Severity
   • Pain scale (0–10), or degree of interference with daily activities.
     Example: “Back pain is 8/10 and prevents walking more than 10 steps.”
8. Provocative/Palliative Factors
   • What makes it worse or better.
     Example: “Worsens with deep breaths, relieved when sitting upright.”
9. Associated Symptoms
   • Other symptoms that occur with the complaint.
     Example: Chest pain with nausea, diaphoresis, and dizziness.
10. Pertinent Negatives
    • Symptoms the patient denies that are important for ruling out conditions.
      Example: “No fever, no cough, no hematuria.”
11. Context and Risk Factors
    • Recent travel, sick contacts, lifestyle, medical history, or occupational risks.
      Example: “Truck driver with long sedentary hours, history of hypertension.”

👉 Many templates use mnemonics like OLD CARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, Severity) or PQRST (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing) to make documentation consistent.

How can you customize an HPI template for different specialties?

While the core HPI template is universal, specialties often emphasize different aspects of the history:

• Emergency Medicine
  • Focus: rapid onset, risk factors, life-threatening differentials.
  • Template emphasizes timing, associated symptoms, and pertinent negatives.
    Example: “Chest pain with SOB, denies trauma, fever, or cough.”
• Primary Care/Internal Medicine
  • Focus: chronicity, impact on daily life, risk factor modification.
  • Templates highlight duration, progression, lifestyle, and comorbidities.
    Example: “Progressive fatigue for 3 months, difficulty climbing stairs, history of diabetes.”
• Pediatrics
  • Caregivers provide the history; emphasis on feeding, growth, and developmental impact.
    Example: “Mother reports fever and irritability, child eating less than usual, decreased urine output.”
• Geriatrics
  • Focus on functional ability, cognition, and polypharmacy.
    Example: “Fall this morning, denies LOC, unable to ambulate since.”
• Psychiatry
  • Emphasis on chronology, mood changes, triggers, psychosocial context.
    Example: “Reports depressed mood for 6 weeks, poor sleep, denies suicidal ideation.”
• Surgery
  • Templates highlight mechanism of injury, severity, timing, and associated risks.
    Example: “Sharp abdominal pain started 6 hours ago, progressively worsening, denies bowel movement since yesterday.”

By tailoring the HPI template to the specialty, clinicians ensure relevance and avoid unnecessary information overload.

What role does technology play in HPI documentation templates?

Technology has transformed how HPIs are documented, moving from handwritten notes to structured electronic templates:

1. Electronic Health Records (EHRs)
   • Most EHRs contain built-in HPI templates with dropdowns, checkboxes, and free-text fields.
   • Benefits: standardization, faster documentation, and integration with past medical history.
   • Limitation: risk of “note bloat” if over-reliance on checkboxes creates cluttered documents.
2. AI-Assisted Documentation
   • Speech-to-text tools allow clinicians to dictate HPIs directly into the system.
   • AI systems can suggest auto-completed HPI templates, flag missing elements (e.g., pertinent negatives), and generate structured narratives.
     Example: After entering “chest pain,” the system prompts for onset, duration, radiation, and risk factors.
3. Specialty-Specific EHR Modules
   • Pediatrics, geriatrics, or psychiatry modules may include customized templates with prompts aligned to that specialty’s priorities.
4. Patient-Entered Data
   • Some EHRs allow patients to fill out symptom questionnaires in the waiting room, which are automatically imported into the HPI template.
   • This saves time and ensures that patient-reported symptoms are directly included in the HPI document.

👉 While technology enhances efficiency, it is vital to avoid over-reliance. Templates should guide, not replace, critical thinking. A good clinician always adapts the structure to the patient’s story rather than forcing the story into rigid fields.

Challenges in Writing HPI and How to Overcome Them

Even though the history of present illness (HPI) is one of the most critical parts of a patient encounter, writing a clear, structured, and clinically meaningful HPI can be challenging. Healthcare providers—especially students and new graduates—often face obstacles that impact the quality of documentation. Below, we’ll explore the common pitfalls in HPI writing, strategies to improve HPI skills over time, and useful resources for ongoing HPI education.

What common pitfalls do healthcare providers face when writing HPI?

Many difficulties in HPI documentation stem from a lack of structure, incomplete data, or overloading the note with unnecessary details. Some of the most frequent pitfalls include:

1. Being Too Vague or General
   • Writing “Patient has chest pain” without describing onset, quality, severity, or associated symptoms.
   • This lacks clinical value and makes it difficult to differentiate between conditions (e.g., myocardial infarction vs. gastroesophageal reflux).
   • ✅ Solution: Use structured mnemonics like OLD CARTS or PQRST to ensure that essential details are captured.
2. Excessive Use of Medical Jargon
   • Overloading the HPI document with abbreviations or highly technical terms can make it confusing for other healthcare providers.
   • ✅ Solution: Strike a balance—use medical terms appropriately but keep descriptions clear (e.g., “sharp, stabbing pain” rather than just “neuralgic”).
3. Mixing HPI with Other History Sections
   • A common error is including past medical history, family history, or review of systems in the HPI template.
   • This creates redundancy and blurs the focus on the present illness.
   • ✅ Solution: Keep the HPI focused on the present complaint and only include past history if it directly influences the current illness (e.g., “Patient with history of asthma presenting with shortness of breath”).
4. Forgetting Pertinent Negatives
   • Neglecting to ask or document what the patient does not have can mislead future providers.
   • Example: In chest pain cases, failing to note “no shortness of breath, no dizziness, no nausea” could leave out critical differentials.
   • ✅ Solution: Always include a few targeted pertinent negatives based on likely conditions.
5. Overloading the Narrative with Irrelevant Details
   • Including every single symptom the patient mentions, even if unrelated, makes the HPI document cluttered.
   • ✅ Solution: Focus on information that contributes to the differential diagnosis. Unrelated findings should go in the Review of Systems.

How can you improve your HPI writing skills over time?

Like any clinical skill, writing a good HPI template entry improves with practice, feedback, and reflection. Strategies include:

1. Practice with Real and Simulated Cases
   • Regularly write HPIs for both clinical encounters and case simulations.
   • Example: Use standardized patient cases or online modules (like Shadow Health) to practice structuring the HPI.
2. Seek Constructive Feedback
   • Ask senior nurses, residents, or attending physicians to review your HPIs.
   • Feedback often highlights whether your HPI document is too vague, too detailed, or missing critical information.
3. Study Model HPI Examples
   • Review HPI templates and sample entries for common conditions (e.g., chest pain, shortness of breath, abdominal pain).
   • Comparing your work with structured HPI examples helps identify areas for improvement.
4. Use Mnemonics Consistently
   • Tools like OLD CARTS and PQRST should become second nature. With repetition, you’ll naturally ask and document all the key elements.
5. Reflect on Patient Outcomes
   • Revisit cases where your initial HPI documentation was used for diagnosis and management.
   • This helps you see how detailed and structured HPIs influence clinical decision-making.

What resources are available for ongoing HPI education?

Healthcare providers have access to many resources for learning how to create accurate, clear, and clinically useful history of present illness templates.

1. Medical Textbooks and Nursing Guides
   • Standard texts on patient assessment (e.g., Bates’ Guide to Physical Examination and History Taking) provide structured approaches and examples.
2. Online Clinical Training Modules
   • Platforms like Shadow Health, iHuman, and case-based learning modules let students practice documenting HPIs in simulated scenarios.
3. Workshops and Clinical Skills Labs
   • Nursing and medical schools often provide structured workshops on history-taking and documentation.
   • These include supervised practice sessions where students fill out HPI templates under guidance.
4. Peer Review and Mentorship
   • Working with peers to review each other’s HPI documents can reveal blind spots.
   • Mentorship from experienced clinicians reinforces best practices.
5. Technology and AI Tools
   • Modern EHR systems and AI-powered assistants provide HPI templates with structured prompts.
   • These tools can remind clinicians to ask about onset, duration, and severity, reducing the likelihood of missing critical details.

Conclusion

Mastering the history of present illness (HPI) is one of the most critical skills for any healthcare professional. It forms the foundation of clinical communication and provides a structured account of the patient’s current illness that guides the entire diagnostic and management process. A well-written HPI not only highlights the chief complaint but also paints a logical and comprehensive picture of the illness, making it easier for other healthcare providers to understand the encounter without confusion or error. By organizing the patient’s story using structured formats like OLD CARTS or PQRST, clinicians can uncover important risk factors, associated symptoms, and the context of the illness that might otherwise be overlooked.

Effective HPI documentation directly improves patient care and outcomes. When the description of a symptom such as chest pain is clear, thorough, and supported with pertinent negatives, it allows practitioners to distinguish between life-threatening conditions like myocardial infarction and less urgent complaints. This level of precision reduces the chance of misdiagnosis, helps avoid unnecessary testing, and supports efficient communication between team members during emergency or routine care. Ultimately, an HPI that captures onset, duration, severity, and progression ensures that treatment decisions are informed by a solid understanding of the patient’s story, not guesswork.

For those seeking to enhance their skills in HPI writing, the next step is consistent practice, reflection, and refinement. Using an HPI template can provide a structured format that keeps documentation logical, concise, and clinically useful. Reviewing high-quality examples, practicing with simulated patients, and seeking feedback from mentors are practical ways to strengthen documentation over time. In addition, adopting technology-driven tools like customizable templates in electronic health records can improve efficiency while ensuring that no key elements are missed.

In essence, the ability to document an accurate, concise, and comprehensive HPI is not just an academic exercise—it is a critical tool that underlies safe, effective, and patient-centered care. By committing to continuous improvement and leveraging available resources, clinicians can transform a patient’s narrative into a diagnostic roadmap that elevates both the quality of communication and the outcomes of patient care.

Frequently Asked Questions

What is an example of HPI?

Example: “The patient is a 54-year-old male presenting with chest pain for the past 2 hours. The pain is described as a heavy pressure radiating to the left arm, worsened by exertion, and partially relieved by rest. Associated symptoms include shortness of breath and nausea. No history of trauma, fever, or cough.”

What are the 8 elements of HPI?

According to CMS documentation guidelines, the 8 elements of HPI are:

• Location (Where is the symptom?)
• Quality (What does it feel like? Sharp, dull, burning?)
• Severity (How bad is it? Often rated on a 0–10 scale)
• Duration (How long has it been present?)
• Timing (When did it start? Is it constant or intermittent?)
• Context (What was happening when it began?)
• Modifying factors (What makes it better or worse?)
• Associated signs and symptoms (Other complaints occurring with it)

What is the HPI history of presenting illness?

The history of present illness (HPI) is a detailed chronological description of the patient’s current medical problem, starting from the chief complaint and expanding into its characteristics, onset, progression, and associated factors. It provides context for the illness and helps clinicians form a diagnostic impression.

What are the 7 HPI questions?

The classic 7 HPI questions often used in clinical interviews are:

1. When did the problem start? (Onset)
2. Where is it located? (Location)
3. What does it feel like? (Quality)
4. How severe is it? (Severity)
5. Is it constant or does it come and go? (Timing)
6. What makes it better or worse? (Modifying factors)
7. What other symptoms are occurring with it? (Associated symptoms)