| Chief complaint | Use definition recommended by the ESC guidelines on syncope reported in Tables 7 |
| Present illness | Circumstances just prior the T-LOC event (predisposing factors, triggers, body position, activity, signs and symptoms of autonomic activation, accompanying symptoms, prodromes) Features of the attack (eyewitness), duration, recovery, consequences (trauma) Previous T-LOC episodes (number, date of occurrence, features, previous tests and treatments) |
| Past medical history | Description of the underlying diseases Medications Social history Family history |
| Physical examination | Findings |
| Electrocardiogram | Findings |
| Tests | List and report of the relevant findings of the tests performed |
| Assessment and diagnosis | Description of the findings that led to the final diagnosis |
| Plan/treatment | Suggested further diagnostic tests or treatment with an explanation of the expected results, as appropriate |
| Follow-up modality | Description and eventual appointment for further visits |
| Chief complaint | Use definition recommended by the ESC guidelines on syncope reported in Tables 7 |
| Present illness | Circumstances just prior the T-LOC event (predisposing factors, triggers, body position, activity, signs and symptoms of autonomic activation, accompanying symptoms, prodromes) Features of the attack (eyewitness), duration, recovery, consequences (trauma) Previous T-LOC episodes (number, date of occurrence, features, previous tests and treatments) |
| Past medical history | Description of the underlying diseases Medications Social history Family history |
| Physical examination | Findings |
| Electrocardiogram | Findings |
| Tests | List and report of the relevant findings of the tests performed |
| Assessment and diagnosis | Description of the findings that led to the final diagnosis |
| Plan/treatment | Suggested further diagnostic tests or treatment with an explanation of the expected results, as appropriate |
| Follow-up modality | Description and eventual appointment for further visits |
| Chief complaint | Use definition recommended by the ESC guidelines on syncope reported in Tables 7 |
| Present illness | Circumstances just prior the T-LOC event (predisposing factors, triggers, body position, activity, signs and symptoms of autonomic activation, accompanying symptoms, prodromes) Features of the attack (eyewitness), duration, recovery, consequences (trauma) Previous T-LOC episodes (number, date of occurrence, features, previous tests and treatments) |
| Past medical history | Description of the underlying diseases Medications Social history Family history |
| Physical examination | Findings |
| Electrocardiogram | Findings |
| Tests | List and report of the relevant findings of the tests performed |
| Assessment and diagnosis | Description of the findings that led to the final diagnosis |
| Plan/treatment | Suggested further diagnostic tests or treatment with an explanation of the expected results, as appropriate |
| Follow-up modality | Description and eventual appointment for further visits |
| Chief complaint | Use definition recommended by the ESC guidelines on syncope reported in Tables 7 |
| Present illness | Circumstances just prior the T-LOC event (predisposing factors, triggers, body position, activity, signs and symptoms of autonomic activation, accompanying symptoms, prodromes) Features of the attack (eyewitness), duration, recovery, consequences (trauma) Previous T-LOC episodes (number, date of occurrence, features, previous tests and treatments) |
| Past medical history | Description of the underlying diseases Medications Social history Family history |
| Physical examination | Findings |
| Electrocardiogram | Findings |
| Tests | List and report of the relevant findings of the tests performed |
| Assessment and diagnosis | Description of the findings that led to the final diagnosis |
| Plan/treatment | Suggested further diagnostic tests or treatment with an explanation of the expected results, as appropriate |
| Follow-up modality | Description and eventual appointment for further visits |
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