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Get and Sign Phone#sHome  Form

Get and Sign Phone#sHome Form

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You have pain rate your pain level on a scale of 0-10 0 no pain 10 most extreme pain Current pain level At worst How would you describe your pain Ache Dull Sharp Burning Shooting Deep Superficial Numbness Tingling Other Are your symptoms Constant Intermittent Is your pain worse at a certain time of day If yes Worse at night Worse in morning Yes No Variable Do you have difficulties getting to sleep due to pain Do you wake due to pain Infrequent If yes of times per night Client Name...
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