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Get and Sign Patient Registration Form Spine and Sport 2020-2022
Respiratory Status Normal Moderate Severe shortness of breath with mild exertion If yes Do you have any condition that is aggravated by exercise Please describe the type of treatment and when SOCIAL HISTORY Marital status Single Married Divorced Widowed Separated Occupation Retired Disabled Student Yes No - Do you drink alcohol Daily Weekly Infrequently Recovering Alcoholic Yes No - Do you use tobacco Smoke packs per day Chew Surgical History Please list any hospitalizations surgeries fractures...Show details
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