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Get and Sign Patient History Form Bnephrologysyracusebbcomb

Get and Sign Patient History Form Bnephrologysyracusebbcomb

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

Heart disease Sleep apnea GI bleeding Frequent UTI Heart failure Allergies Hepatitis Irregular heart Heart valve problem Gout Gallbladder Seizures Heart murmur Vascular disease Cancer Thyroid Other Allergies Social History check all that apply Occupation Single Married Smoker Yes No If yes for how long Alcohol Use If yes how much Divorced packs/day Immunizations check all that apply and include date Pneumovax Flu Vaccine Preventive Screening check box if yes and include date...
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