PATIENT MEDICAL HISTORY
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CHIEF COMPLAINT - Why are you seeing the doctor today?
CHIEF COMPLAINT - Why are you seeing the doctor today?
Injured Body Part (Check all that apply)
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Your Current Medical Problem is the result of:
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This occurred during:
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HISTORY OF PRESENT ILLNESS:
HISTORY OF PRESENT ILLNESS:
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Describe it. Check all that apply.
When does your pain and discomfort occur? Check all that apply:
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What makes your pain or discomfort better? Check all that apply
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If yes, check all previous testing done:
Medications
Medications
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Current Medications (If you don't know how to spell the medication, please inform the nurse when seen)
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