I probably should not have used the term "secondary to" in explaining "associated signs and symptoms." The plain wording itself, as being symptoms
associated with the chief complaint, is more accurate.
I have seen a number of sources, but nothing from a formal source. Here are a couple that I have come across:
From
http://www.emergencymedicine.mckessonrevenews.com/index.php/archives/4-a-clear-picture-of-hpi: Associated Signs and Symptoms: Signs and/or symptoms that accompany the original complaint or symptom (i.e., mild burning knee pain has been intermittent since yesterday after mowing the yard ? no relief with acetaminophen ? also some noted swelling; frequent intense throbbing headache that started this morning after an argument with spouse ? some relief after lying down ? also pain in neck and jaw). The writer's point is that, in the first example, the chief complaint is knee pain, the quality is painful, and the associated S&S is swelling. In the second example, the chief complaint is headache, the quality is throbbing, and the associated D&D is pain in neck and jaw.
And here is an excellent breakdown of all the HPI elements from FTessaBartels at
https://www.aapc.com/memberarea/forums/showthread.php?t=24901
Location - Where - the site, is it diffuse, localized?
Quality - What kind - sharp, dull, constant, intermittent
Severity - How bad is it - pain scale 1-10, mild, severe
Duration - How long has it been present - since yesterday, for 2 weeks, fell on Tuesday
Timing - Is there a pattern - every morning, continuous, repetitive
Context - What Brings it on - with exercise, when standing, noted on X-ray
Modifying factors - What makes it better or worse - better with Tylenol, Rx had no effect
Associated Signs - What comes with it - other symptoms that accompany the chief complaint.