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Hingham Surgery NHS GP Practice in Norfolk

Urinary tract infection assessment

Urinary Tract Infection Assessment

Section

Initial questions

Do you feel very unwell? *

Yes

Do you have a high temperature or fever? *

Yes

Do you have severe loin or flank pain? *

Yes

How would you describe the severity of your symptoms? *

Mild

Moderate

Severe

Are you able to carry out most of your usual activities? *

Yes

Do you feel nauseated or have you vomited?

Yes

Background questions

Are you prone to urine infections? *

Yes

Could you be pregnant? *

Yes

N/A

Have you had a change in your vaginal discharge? *

Yes

N/A

Have you had any new sexual partners in the last 6 months? *

Yes

N/A

Have you tried any treatments so far? *

Yes

What treatments have you tried? *

Are you allergic or sensitive to antibiotics? *

Yes

Which antibiotic(s) are you allergic or sensitive to?

Key symptoms and signs

Do you have pain or burning when you urinate? *

Yes

Are you having to urinate in the night now and is this a new symptom for you? *

Yes

I always pass urine in the night, and this is normal for me

Is your urine cloudy? *

Yes

Other symptoms and signs

When you want to pass urine, do you have an overwhelming urge to do so immediately? *

Yes

Are you passing urine more frequently? *

Yes

Is there blood seen in your urine? *

Yes

Do you have lower abdominal pain? *

Yes

Expectations

What are your expectations? *

E.g. Us to prescribe you antibiotics, just do a urine test, appointment with a GP, etc.

If you are human, leave this field blank.

26-28 Hardingham Street
Hingham
Norwich
NR9 4JB

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01953 850237

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