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Eye Care ServicesOCLI Vision  Form

Eye Care ServicesOCLI Vision Form

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To anesthesia Yes/No Do you drink alcohol Yes/No How much Do you smoke Yes/No How much Yes No GENERAL/CONSTITUTIONAL fever heatstroke weight loss weight gain unusually tired serious childhood illness etc. EAR NOSE THROAT hard of hearing congestion earache cough dry mouth etc. CARDIOVASCULAR pacemaker defibrillator High BP racing pulse etc. RESPIRATORY congestion wheezing short of breath etc. GASTROINTESTINAL stomach upset diarrhea constipation hernia ulcers etc. GENITAL KIDNEY BLADDER painful...
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