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Patient History Form

Patient History Form

Use a patient history form 0 template to make your document workflow more streamlined.

Pulmonary Endocrine Problems Peptic Ulcer Disease Disease GERD Seizures Clotting Disorder Glaucoma Stroke Congestive Heart Failure Hepatitis Ulcerative Colitis Personal Surgical History: Have you ever had any of the following surgeries? (Check if yes) Adrenal Gland Surgery Colon Surgery Kidney Surgery Appendectomy Coronary Artery Bypass Graft Neck Surgery Bariatric Surgery Esophagus Surgery Prostate Surgery Bladder...
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