私が使っていた問診・サマリーの型を書いておく。
覚えているものを文字に起こしただけなので、英語として間違っているかもしれない。
NativeにCheckしてもらってから、好きにアレンジして使ってほしい。

Hello, I am Dr. 〇〇, I am taking care of you today. I will ask some questions and perform a Physical examination for you. How can I address you?

What brought you here today?
Could you tell me more about 〇〇?
When did it start?
How did it start?
Could you describe your 〇〇 more?
On a scale 1-10, 10 being the worst pain, please rate your pain.
What makes it worse? What makes it better?
Is it constant or it comes and goes?
Is it getting worse?
Do you have any other symptoms?→Do you have 〇〇?でROSを聞く

Let me ask you about your medical condition. 
Do you have any medical issues? Have you had similar problems before?
Have you had surgeries before?
Have you ever been hospitalized?
Have you had  trauma?
Are you taking any medications?
Are you allergic to anything?
Does your family has any medical issues?
I am going to ask you about your lifestyle.
Have you ever smoked? Do you drink Etoh?(M>3cans/d, F>2cans/dでCAGEを聞く) Have you ever used any recreational drugs?
What do you do for living? Who do you live with?
Now, I have to ask you some sexual questions because these are important. Everything you tell me is confidential. 
Are you sexually active? Who is your partner/How many partners have you had in the past 6 months? Male?Female?or both?
Do you use condom?
How many times have you ever been pregnant? How many children you have? When was your last period? Was it regular?

Thank you for answering my questions. Now, I am going to perform a PE. I wash hands first. 

説明しながらPEをとる。
 
Let me summarize
You have -- days of ----, ---, ---, ---(症状・PEの陽性所見を合計5つ挙げる). Based on what you told me, you might have ▲▲(特定の診断名), which is caused by---. (診断の患者への説明) 
To figure out what is going on, I would like to run 〇〇 image study, which is called 〇〇 CT/MRI and blood test to check inflammation. (検査をする理由も説明する)
Do you agree with my plan?
Do you have any questions?

Lastly, I strongly recommend you to stop smoking to improve your health. Are you interested in that?
Our counselor and support group will help you. I will make you an appointment afterward. 
Thank you.