UTI Proforma

Are you concerned that you have a urine infection?

If yes, what symptoms do you have?

Are you pregnant?

Stinging or burning when passing urine

Pain or discomfort in lower abdomen

Frequent need to urinate

Sudden urge to urinate

Blood in Urine

Date of last period?

Pain in the flanks

Temperature / Shivering

Do you have a catheter inserted?

How long have you had these symptoms?

Any other information?