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SHENANDOAH ONCOLOGY PC NEW PATIENT HISTORY FORM Please
Last prostate exam Last PSA screening Last bone density scan Last pneumonia vaccine SOCIAL HISTORY Substance Do you use Alcohol Tobacco Caffeine Recreational Drugs What Type How Much How Often If quit when FAMILY HISTORY Please list any illnesses in your family including all cancers i.e. breast cancer ovarian cancer etc. and blood disorders i.e. anemia blood clotting disorders etc. Relationship Diagnosis Age Illness Deceased Mother Y N Brothers Father Grandmother P Y N Sisters Grandfather M...
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