Clinical template
HPI Template with Examples
The history of present illness (HPI) is the story of this problem, from onset to this room. OLDCARTS and OPQRST are checklists so you do not skip character, radiation, or what they already tried. Use the blank below, then three fictional Canadian cases: chest pain, migraine, and abdominal pain.
Blank HPI template
Copy this into the Subjective section of a SOAP, a consult, or a Scribeberry custom template. Write in paragraphs or in labelled lines. Pertinent negatives belong here, not in a 14-system ROS.
HPI (OLDCARTS / OPQRST)
Patient: [initials, age, sex] | Setting: | Historian: patient / caregiver (reliability) Chief complaint (their words if useful): O — Onset: when it started, sudden vs gradual, what they were doing L — Location: point with one finger if they can; laterality D — Duration: constant vs intermittent; length of each episode; overall course C — Character: sharp, dull, pressure, burning, colicky, thunderclap, tearing A — Aggravating / associated: movement, food, exertion, position, inspiration; associated symptoms R — Relieving / radiation: rest, antacids, triptan, heat; radiation path T — Timing: night, after meals, menstrual, circadian; progression S — Severity: 0–10 now and at worst; effect on work, sleep, walking Treatments tried (drug, dose, effect): Pertinent negatives / red flags asked: Relevant context: similar episodes, risk factors, last menstrual period if applicable, substances OPQRST mapping if you prefer: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time
Fictional patients
Every example on this page uses made-up names and findings. They are teaching material. They are not a substitute for college standards or your own clinical judgment. Review every generated HPI before it enters the chart.
OLDCARTS and OPQRST
Both mnemonics cover the same ground. OLDCARTS (Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity) is common in Canadian clerkship teaching. OPQRST (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time) is common in emergency medicine. Pick one and finish it. The failure mode is stopping after onset and a pain score.
| Letter | Question to ask | Example of a usable phrase |
|---|---|---|
| Onset | When did this start, and what were you doing? | Sudden at 06:40 while shovelling; not a slow build over days |
| Location / region | Point to it. Does it move? | Retrosternal, one finger, no radiation to arm or jaw |
| Duration / time | How long does each bout last? Is it getting worse? | Each episode 20–40 min; three episodes in 24 h |
| Character / quality | If this were a sound or a texture, what would it be? | Pressure, 'an elephant,' not sharp, not tearing through to the back |
| Aggravating / provocation | What makes it worse? Food, stairs, breath, touch? | Worse first flight of stairs; not worse with swallowing |
| Relieving / palliation | What did you try, including drugs and rest? | Sat down, Tums x 2, no change; GTN not available |
| Severity | 0–10 now and at worst, and what you cannot do | 7/10 at worst, 3/10 now; could not finish shovelling |
Associated symptoms are where red flags live: diaphoresis and dyspnea with chest pain; neck stiffness and fever with headache; pregnancy and shoulder-tip pain with abdominal pain. Write that you asked. CMPA and college files on missed ACS, SAH, and ectopic often show a complete-looking note that never recorded the negative.
How to write an HPI that another clinician can use
Open with a one-line frame: age, relevant risk, and the complaint in time. Then tell the story in order. End with treatments tried and the negatives that change the differential. Do not put your diagnosis in the HPI. 'Here for ACS' is an assessment leaking backward.
Quantify. 'A few days' becomes 72 hours. 'A lot of ibuprofen' becomes 400 mg x 6 yesterday. For abdominal pain, last stool, last menstrual period, and ability to keep water down belong in the HPI, not as an afterthought in ROS. For headache, worst-onset, trauma, anticoagulation, and visual change belong in the same paragraph as the pain.
Example 1 — chest pain
Family medicine / urgent visit
55-year-old man, Mississauga. 18-minute same-day appointment. Fictional.
55M, known hypertension and 25 pack-year smoking history (quit 2022), presents with retrosternal chest pressure. Onset: Today 06:40 while shovelling snow, sudden over 1–2 minutes. Similar milder ache walking to the bus twice in the last 10 days, each lasting <10 min, which he ignored. Location: Retrosternal, palm-sized; no epigastric start. Duration: 25 minutes at worst this morning; now 40 minutes later, still 3/10 in clinic. Character: Pressure, "like someone sitting on me." Not sharp, not pleuritic, not tearing through to the back, not positional. Aggravating / associated: Exertion (shovelling, stairs). Associated diaphoresis and mild dyspnea this morning. No nausea, no syncope, no palpitations, no cough, no fever, no calf swelling. Relieving / radiation: Sat in the car, eased from 7/10 to 3/10 over 15 min. No radiation to arm, jaw, or back. Antacid not tried. No GTN at home. Timing: Morning, with exertion; not nocturnal, not after meals specifically. Severity: 7/10 at worst, 3/10 now. Could not finish the driveway. Tried: Rest only. Red flags asked: no thunderclap, no neuro deficit, no GI bleed history. Context: Brother CABG at 58. Takes ramipril 10 mg, amlodipine 5 mg. No cocaine. Walks dog daily until this week.
Example 2 — migraine
Neurology-adjacent family practice
27-year-old woman, Montreal. Known migraine, this attack different. Fictional.
27F with migraine without aura since age 16, presents with a 36-hour headache that is worse than her usual and has not responded to her usual triptan. Onset: Yesterday 14:00 at her desk, gradual over 30 min (usual is 15 min). No trauma. Not thunderclap. She woke today with it still present. Location: Right frontotemporal, behind the eye; usual side. Duration: Continuous 36 h; usual attacks last 8–12 h if she treats early. Character: Throbbing, photophobia, phonophobia. Not the "worst of my life." No neck stiffness. No fever. Aggravating / associated: Light, screens, bending. Associated nausea, one vomit this morning. No diplopia, no unilateral weakness, no speech change, no confusion, no seizure. Visual: usual blur, no scintillating scotoma this time (she sometimes has that; absent today). Relieving / radiation: Dark room helps a little. Rizatriptan 10 mg at 14:30 yesterday and again at 20:00: partial, pain from 8/10 to 6/10. Ibuprofen 400 mg x 3. No radiation to neck. Timing: Day 2 of menses (usual trigger). Sleep-deprived after a deadline. Severity: 8/10 last night, 6/10 now. Missed work today. Tried: Rizatriptan x 2, ibuprofen, ondansetron ODT from old script (helped nausea). Red flags asked: no thunderclap, no fever/stiff neck, no new neuro deficit, not pregnant (LMP 2 days ago, contraception implant), no anticoagulation, no cancer. Context: Baseline 3–4 migraines/month. No MOH pattern (triptan <8 days/month). No head injury.
Example 3 — abdominal pain
After-hours clinic
36-year-old woman, Calgary. Right-upper-quadrant pain. Fictional.
36F, previously well, presents with 18 hours of right-upper-quadrant and epigastric pain after a fatty meal. Onset: Last night 22:00, 90 min after fried chicken, gradual then steadily worse. Not instantaneous. No trauma. Location: RUQ, radiates to the right scapula. She points under the right costal margin. Duration: Constant since 22:00, waves of worse pain lasting 20 min. Character: Deep, aching, colicky waves. Not tearing. Not burning up into the chest. Aggravating / associated: Worse lying on the right side and after sips of coffee this morning. Associated nausea, two vomits of food then bile. No diarrhea. No dysuria, no vaginal bleeding, no discharge. No fever at home (no thermometer). No jaundice noticed. No pruritus. LMP 3 weeks ago, regular, not pregnant to her knowledge, IUD in situ. Relieving / radiation: Unsure acetaminophen 1 g at 23:00, no change. Radiation to right scapula, not to left arm or groin. Timing: Post-prandial, nocturnal start; no prior identical attacks (occasional "indigestion" after pizza x 1 year). Severity: 8/10 at 02:00, 6/10 now. Could not sleep. Walking hunched. Tried: Acetaminophen 1 g, rest, heating pad. Red flags asked: no hypotension symptoms (no syncope), no GI bleeding, no pregnancy symptoms, no rigid-board description, no inability to pass stool/gas (flatus this morning). Context: BMI 31. No alcohol binge. No anticoagulant. No prior cholecystectomy. Last travel 8 months ago (no hepatitis risk she knows).
Mistakes that show up in HPIs
- Stopping after onset and a pain score.
- Putting the diagnosis in the first line ('patient here for cholecystitis').
- Skipping pregnancy status in abdominal pain in a person who can be pregnant.
- Skipping exertional detail in chest pain, then calling the pain 'atypical' without data.
- Thunderclap never asked in a severe headache.
- Treatments tried with no dose, so the next clinician repeats a failed 400 mg of ibuprofen.
- Copy-forwarding last visit's HPI for a new complaint.
CMPA's documentation advice is consistent: the record has to show that red flags were considered. Colleges expect the signed note to match the visit you did. An AI HPI that invents 'no chest pain' when you never asked is your problem once you sign it.
HPI inside SOAP, referrals, and ED notes
In SOAP, the HPI is the body of Subjective. In a referral, it is the 'history of present problem' paragraph. In ED, it is often a tighter OPQRST plus EMS times. The content does not change; the length does. Do not hide the only pertinent negative inside a ROS nobody reads.
Draft the HPI from the visit
Scribeberry listens to the encounter, or takes dictation, and drafts OLDCARTS in your SOAP or consult template. Edit the negatives and the numbers, then Smart Push into Accuro, OSCAR, Jane, or any web EMR. Pro is $99/month after the free trial.
Frequently asked questions
What is an HPI in a medical note?
The history of present illness is the chronological story of this complaint: onset, location, duration, character, what makes it better or worse, radiation, timing, severity, associated symptoms, and treatments already tried. It sits under the chief complaint and above the past history.
Should I use OLDCARTS or OPQRST?
Either. OLDCARTS is common in Canadian clinics and clerkship. OPQRST is common in emergency medicine. Finish the list. The mnemonic is a memory aid, not a heading the patient needs to hear.
How long should an HPI be?
Long enough that another clinician can reconstruct the timeline and the red flags you asked. Uncomplicated presentations often fit in a short paragraph. Chest pain, headache, and abdominal pain usually need the full mnemonic plus associated symptoms.
Can Scribeberry write an HPI?
Yes. Record or dictate the history, generate into your template, and check that every negative in the draft is one you actually asked. Custom templates can lock OLDCARTS headings in place.
Templates
