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Past Medical History
• • •
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Past Medical History Comments
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Past Ocular History
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Past Ocular History
• • •
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Past Ocular History SIDE
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Past Ocular History Comments
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Past Oculoplastic History
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Past Oculoplastics History
• • •
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Oculoplastic Surgery SIDE
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Past Oculoplastic History Comment
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Family History
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No blindness or Ptosis
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Father's Past Medical History
• • •
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Mother's Past Medical History
• • •
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Sibling(s)' Past Medical History
• • •
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Grandparent's Past Medical History
• • •
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Comments
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Social History
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Tobacco
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Alcohol
• • •
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Other illicit substances
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Occupation
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Chemical exposure
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Travel
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