Learn what a review of systems is, explore all 14 ROS categories, and use complete ROS examples, templates, and documentation guidance.
A review of systems (ROS) is a structured record of symptoms reported by a patient across body systems. Clinicians use the ROS to identify associated symptoms, document pertinent positives and negatives, and uncover concerns that may not appear in the chief complaint. The ROS may be limited to a few relevant systems or be a complete 14-point review depending on the patient, presenting problem, specialty, and setting.
An ROS is a series of questions used to identify symptoms a patient is currently or recently experiencing. The information is grouped by body system and is primarily subjective, reported by the patient, caregiver, or other historian.
Example: Cardiovascular: Reports intermittent palpitations. Denies chest pain, syncope, or leg swelling. This documents patient-reported symptoms and does not describe physical exam findings.
ROS stands for review of systems. It organizes patient-reported symptoms by physiologic system and may include reported symptoms, relevant denials, symptoms associated with the chief complaint, additional concerns found during history, and limitations affecting the review.
A clinically useful ROS supports the differential diagnosis, identifies red flags, and provides context for the assessment and plan. Templates should not auto-record negatives for systems that were not discussed.
Both ROS and history of present illness (HPI) are parts of the patient history, but they serve different purposes. The HPI describes the main problem in detail; the ROS screens for symptoms across relevant systems.
HPI: The patient reports intermittent substernal chest pressure that began three days ago. It occurs while climbing stairs and improves after several minutes of rest. ROS: Cardiovascular: Reports exertional chest pressure and occasional palpitations. Denies syncope or peripheral edema. Respiratory: Denies cough, wheezing, or hemoptysis. Gastrointestinal: Reports occasional reflux. Denies vomiting or abdominal pain.
Some overlap between HPI and ROS is normal, but repeating identical text across both can bloat the note without adding clinical clarity.
A complete ROS commonly includes the following 14 categories. Organizations may combine or rename categories based on documentation standards.
A 14-point ROS addresses all 14 commonly recognized body-system categories. Terms include complete ROS, comprehensive ROS, or 14-point ROS. It may be appropriate for new-patient visits, comprehensive assessments, specialty evaluations, or clinically complex encounters, but is not required for every visit.
Constitutional: Denies fever, chills, or unintended weight change. Musculoskeletal: Reports right knee pain, swelling, and difficulty climbing stairs. Denies hip or ankle pain. Neurological: Denies numbness, tingling, or focal lower-extremity weakness. Integumentary: Denies open wound, redness, rash, or skin discoloration. Cardiovascular: Denies calf swelling or lower-extremity edema.
Constitutional: Denies fever, chills, fatigue, or unintended weight change. Cardiovascular: Denies chest pain, palpitations, syncope, or edema. Respiratory: Denies cough, wheezing, or shortness of breath. Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea, or constipation. Neurological: Denies headache, dizziness, weakness, numbness, or tingling.
Constitutional: Denies fever, chills, fatigue, night sweats, or unintended weight change. Eyes: Denies vision changes, eye pain, redness, or discharge. Ears, Nose, Mouth, and Throat: Denies hearing changes, ear pain, congestion, sore throat, hoarseness, or difficulty swallowing. Cardiovascular: Denies chest pain, palpitations, syncope, orthopnea, or edema. Respiratory: Denies cough, shortness of breath, wheezing, hemoptysis, or sputum production. Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea, constipation, reflux, or blood in the stool. Genitourinary: Denies dysuria, frequency, urgency, hematuria, or incontinence. Musculoskeletal: Denies joint pain, muscle pain, swelling, stiffness, back pain, or gait changes. Integumentary: Denies rash, itching, wounds, or new skin lesions. Neurological: Denies headache, dizziness, weakness, numbness, tingling, tremor, or seizures. Psychiatric: Denies depression, anxiety, hallucinations, suicidal thoughts, or sleep disturbance. Endocrine: Denies heat intolerance, cold intolerance, excessive thirst, or excessive urination. Hematologic and Lymphatic: Denies easy bruising, prolonged bleeding, anemia, blood clots, or swollen lymph nodes. Allergic and Immunologic: Denies recurrent infections or new allergic reactions.
This example is a documentation model and should be adapted to each encounter.
An effective ROS should be accurate, relevant, and consistent with the rest of the note.
Templates are organizational tools and do not replace appropriate questioning or clinician judgment.
Cardiovascular: Reports exertional chest pressure and occasional palpitations. Denies syncope, orthopnea, or lower-extremity edema. Respiratory: Denies cough, wheezing, shortness of breath at rest, or hemoptysis. Gastrointestinal: Reports occasional reflux. Denies vomiting or severe abdominal pain.
Neurological: Reports intermittent frontal headache and light sensitivity. Denies focal weakness, numbness, seizure activity, or loss of consciousness. Constitutional: Denies fever, chills, or unexplained weight loss. Eyes: Denies vision loss, double vision, or eye pain.
Gastrointestinal: Reports right lower abdominal pain, nausea, and reduced appetite. Denies vomiting, diarrhea, constipation, or blood in the stool. Genitourinary: Denies dysuria, hematuria, or flank pain. Constitutional: Denies fever or chills.
Musculoskeletal: Reports left shoulder pain with overhead movement. Denies neck, elbow, or wrist pain. Neurological: Denies numbness, tingling, or weakness in the arm. Integumentary: Denies bruising, open wound, redness, or rash.
Psychiatric: Reports anxiety, poor sleep, and difficulty concentrating. Denies hallucinations or current suicidal thoughts. Neurological: Denies seizure activity, syncope, or new focal weakness. Constitutional: Reports fatigue. Denies fever or unintended weight loss.
| Review of systems | Physical examination |
|---|---|
| Primarily subjective | Primarily objective |
| Based on symptoms reported by the patient | Based on findings observed, measured, or elicited by the clinician |
| Part of the patient history | Part of the clinical examination |
| Example: 'Patient denies wheezing' | Example: 'Expiratory wheezing heard bilaterally' |
ROS and physical exam may differ (e.g., patient denies wheeze while clinician hears wheeze). This can reflect important differences between perception and objective findings.
A complete 14-point ROS is not automatically required to support higher-level office or outpatient E/M services. Code selection is generally based on medical decision-making or total time. Documentation should still be medically appropriate and meet payer or organizational requirements.
AI medical documentation tools can convert patient-clinician conversations into structured draft notes, but the generated ROS still requires clinician review and verification.
A review of systems is a structured inventory of patient-reported symptoms organized by body system. Quality ROS documentation is accurate, relevant, and consistent with the rest of the note.
The best ROS is not necessarily the longest; it accurately records the symptoms that matter for the encounter.
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