The review of systems, often called ROS, is a very important part of medical and clinical documentation. It helps healthcare providers understand how a patient feels across different body systems. It also helps find hidden symptoms that the patient may not mention on their own. Many students and new clinicians find ROS confusing at first, but once you understand the structure and purpose, it becomes easy and very useful.
In this guide, you will learn what a review of systems is, why it matters, how to write it step by step, and how to document it clearly using simple words. We will also share full examples, common mistakes, templates, and practical tips that you can use in real clinical settings.
What Is a Review of Systems (ROS)?
The review of systems is a structured list of questions that a healthcare provider asks a patient. These questions focus on different body systems such as the heart, lungs, stomach, brain, skin, and others. The goal is to check for symptoms that may not be obvious or already discussed.
In simple words, ROS answers this question:
“How is each part of the patient’s body functioning?”
The review of systems is based on what the patient says. It does not include test results, lab values, or physical exam findings. It only includes symptoms that the patient reports, either as present or absent.
For example, a patient may come in for knee pain. During the ROS, the provider may ask about chest pain, shortness of breath, headaches, stomach issues, or mood changes. These questions help make sure nothing important is missed.
Why the Review of Systems Is Important
The review of systems plays a very important role in patient care. It supports diagnosis, improves safety, and helps with legal and billing requirements. Many errors in healthcare happen because symptoms were not asked about or documented properly. ROS helps prevent that.
Here are some key reasons why ROS matters:
- It helps find hidden symptoms
- It supports accurate diagnosis
- It improves communication between providers
- It creates a clear medical record
- It supports medical coding and billing
- It protects providers legally
A well-written review of systems shows that the provider did a complete evaluation. It also helps future providers understand the patient’s health history better.
Review of Systems vs History of Present Illness (HPI)
Many people confuse ROS with HPI, but they are not the same. Both are important, but they serve different purposes.
The History of Present Illness (HPI) focuses on the main problem. It describes the symptoms related to the chief complaint in detail. It answers questions like when the problem started, how severe it is, and what makes it better or worse.
The Review of Systems (ROS) looks beyond the main problem. It checks other body systems to see if there are any additional symptoms.
Simple Comparison Table
| Feature | HPI | ROS |
|---|---|---|
| Focus | Main problem | All body systems |
| Detail level | Very detailed | Short and structured |
| Symptom source | Related to complaint | Unrelated or related |
| Purpose | Understand main issue | Find hidden symptoms |
Both sections work together to give a full picture of the patient’s health.
How Many Systems Are in a Review of Systems?
A full review of systems usually includes 14 body systems, according to common medical standards. However, not every visit requires reviewing all systems. The number of systems reviewed depends on the visit type, patient condition, and documentation needs.
Common Review of Systems Categories
- Constitutional
- Eyes
- Ear, Nose, Throat (ENT)
- Cardiovascular
- Respiratory
- Gastrointestinal
- Genitourinary
- Musculoskeletal
- Integumentary (Skin)
- Neurological
- Psychiatric
- Endocrine
- Hematologic/Lymphatic
- Allergic/Immunologic
- Nursing
You may document a problem-focused ROS, extended ROS, or complete ROS depending on the situation.
Types of Review of Systems
There are three main types of ROS used in clinical practice. Understanding these types helps you know how much detail is required.
Problem-Focused ROS
This type includes only one body system related to the main complaint. It is short and used in simple or follow-up visits.
Example:
Musculoskeletal: Reports right knee pain. Denies swelling or stiffness.
Extended ROS
This includes two to nine body systems. It is common in outpatient and specialty visits.
Example:
Cardiovascular: Denies chest pain or palpitations.
Respiratory: Denies shortness of breath or cough.
Neurological: Reports occasional headaches.
Complete ROS
This includes ten or more systems. It is used in detailed evaluations, hospital admissions, or new patient visits.
Example:
All systems reviewed and negative except as noted in HPI.
How to Write a Review of Systems (Step by Step)
Writing a review of systems is easier when you follow a simple structure. The key is to be clear, brief, and accurate.
Step 1: Ask System-Based Questions
Ask simple, direct questions related to each body system. Use everyday language that patients understand.
For example:
- “Do you feel tired or have fever?”
- “Any chest pain or fast heartbeat?”
- “Any stomach pain or nausea?”
Step 2: Record Patient-Reported Symptoms
Only write what the patient says. Do not add your own interpretation or test results.
Correct:
Reports nausea and abdominal pain.
Incorrect:
Patient has gastritis.
Step 3: Use Positive and Negative Findings
Document both symptoms that are present and symptoms that are denied.
Example:
Denies chest pain, dizziness, or fainting.
Step 4: Keep Language Simple and Consistent
Use short phrases. Avoid long sentences. Use the same style for each system.
Common Review of Systems Sections with Examples
Below are detailed explanations and examples for each major ROS category.
Constitutional System
This system focuses on general symptoms that affect the whole body. These symptoms often give early clues about infection, chronic illness, or systemic disease.
Common questions include weight change, fever, fatigue, and appetite changes.
Example Documentation:
Constitutional: Reports fatigue and low energy for two weeks. Denies fever, chills, or weight loss.
Cardiovascular System
This system focuses on heart and blood circulation symptoms. These symptoms can be serious and should always be asked about.
Common symptoms include chest pain, palpitations, swelling, and shortness of breath with activity.
Example Documentation:
Cardiovascular: Denies chest pain, palpitations, dizziness, or leg swelling.
Respiratory System
This system focuses on breathing and lung function. It is especially important in infections and chronic conditions.
Common symptoms include cough, shortness of breath, wheezing, and chest tightness.
Example Documentation:
Respiratory: Reports mild shortness of breath with exertion. Denies cough or wheezing.
Gastrointestinal System
This system includes symptoms related to digestion and bowel habits.
Common symptoms include nausea, vomiting, abdominal pain, diarrhea, constipation, and blood in stool.
Example Documentation:
Gastrointestinal: Reports intermittent abdominal pain and nausea. Denies vomiting, diarrhea, or blood in stool.
Genitourinary System
This system focuses on urinary and reproductive symptoms.
Common symptoms include pain with urination, frequent urination, incontinence, and discharge.
Example Documentation:
Genitourinary: Denies pain with urination, urgency, or blood in urine.
Musculoskeletal System
This system focuses on muscles, joints, and movement.
Common symptoms include joint pain, stiffness, swelling, weakness, and limited movement.
Example Documentation:
Musculoskeletal: Reports lower back pain. Denies joint swelling or muscle weakness.
Neurological System
This system focuses on the brain, nerves, and coordination.
Common symptoms include headaches, dizziness, numbness, tingling, seizures, and memory problems.
Example Documentation:
Neurological: Reports occasional headaches. Denies dizziness, weakness, or numbness.
Psychiatric System
This system focuses on mood, thoughts, and behavior.
Common symptoms include anxiety, depression, sleep problems, mood changes, and suicidal thoughts.
Example Documentation:
Psychiatric: Reports increased anxiety. Denies depression, hallucinations, or suicidal thoughts.
Skin (Integumentary) System
This system focuses on the skin, hair, and nails.
Common symptoms include rash, itching, wounds, and color changes.
Example Documentation:
Skin: Denies rash, itching, or skin changes.
Endocrine System
This system focuses on hormone-related symptoms.
Common symptoms include heat or cold intolerance, excessive thirst, and frequent urination.
Example Documentation:
Endocrine: Denies heat or cold intolerance. No excessive thirst.
Hematologic and Lymphatic System
This system focuses on blood and immune symptoms.
Common symptoms include easy bruising, bleeding, and swollen lymph nodes.
Example Documentation:
Hematologic/Lymphatic: Denies easy bruising or swollen lymph nodes.
Allergic and Immunologic System
This system focuses on allergies and immune responses.
Common symptoms include seasonal allergies, frequent infections, and reactions.
Example Documentation:
Allergic/Immunologic: Reports seasonal allergies. Denies frequent infections.
Review of Systems Checklist Template
Here is a simple and reusable ROS Checklist template:
Common Mistakes in Writing Review of Systems
Many errors happen in ROS documentation. Avoiding these mistakes improves quality and accuracy.
Common mistakes include:
- Copy-pasting without asking questions
- Writing diagnoses instead of symptoms
- Mixing ROS with physical exam
- Using vague language
- Documenting systems not reviewed
Always document only what you actually asked and what the patient said.
Review of Systems in SOAP Notes
In SOAP notes, the review of systems is usually included in the Subjective (S) section. It supports the patient’s story and adds clinical depth.
A clear ROS makes SOAP notes stronger and more complete, especially in therapy, primary care, and specialty settings.
Review of Systems in Mental Health and Therapy
In mental health settings, ROS may focus more on psychiatric, neurological, sleep, and somatic symptoms. It helps rule out medical causes of mental symptoms.
Example:
Neurological: Denies headaches or seizures.
Psychiatric: Reports low mood and poor sleep. Denies suicidal thoughts.
Final Thoughts
The review of systems is a powerful clinical tool. It helps providers look beyond the main complaint and understand the patient as a whole. When written clearly and simply, it improves care, reduces errors, and strengthens documentation.
You do not need complex words or long sentences. Simple language, clear structure, and honest documentation are enough. With practice, writing ROS becomes fast, easy, and natural.
Whether you are a student, clinician, therapist, or documentation specialist, mastering the review of systems will make your notes better and your patient care stronger.
Dr. Connor Yost is an Internal Medicine resident at Creighton University School of Medicine in Arizona and an emerging leader in clinical innovation. He currently serves as Chief Medical Officer at Skriber, where he helps shape AI-powered tools that streamline clinical documentation and support physicians in delivering higher-quality care. Dr. Yost also works as a Strategic Advisor at Doc2Doc, lending his expertise to initiatives that improve financial wellness for physicians and trainees.
His professional interests include medical education, workflow redesign, and the responsible use of AI in healthcare. Dr. Yost is committed to building systems that allow clinicians to spend more time with patients and less on administrative tasks. Outside of medicine, he enjoys photography, entrepreneurship, and family life.
