PAST MEDICAL HISTORY
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MEDICATIONS
MEDICATIONS
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MEDICATIONS CONTINUED
MEDICATIONS CONTINUED
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SOCIAL HISTORY
SOCIAL HISTORY
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ALLERGIES
ALLERGIES
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PAST MEDICAL HISTORY
PAST MEDICAL HISTORY
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PAST SURGERIES
PAST SURGERIES
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FAMILY HISTORY
FAMILY HISTORY
List medical illnesses affecting your immediate family. i.e. diabetes, heart disease, cancer, etc.
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