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Psych hx
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Prev. psychiatrist
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Prev. therapists
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Meds hx
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Meds hx details
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Previous psych hosp
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Past psych hosp details
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Hx of self harm
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Self-harm details
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Hx of aggression/homicidality
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Aggr. details
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Medical History
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PCP
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PCP Contact Information
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Birth
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Birth time details
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Birth details
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Birth details, additional
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Dev hx
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Milestones comments
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Past med hx
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Past Medical History Freewrite
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Childhood illnesses
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Comments
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Childhood Immunizations
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Comments
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Past surgical hx
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Past surg. hx free write
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Fam hx
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Father's Med Hx
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Comments
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Mother's MH
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Comments
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Sibling(s)' MH
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Comments
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Other relatives' MH
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Comments
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Social History
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Marital Status
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Comments
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Living Arrangements
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Living arrg. comments
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Patient's diet
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Educ. status
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Grade level
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School name
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IEP/504 plan?
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Educ. Comments
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Hobbies/activities
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Occupational goals
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Potential Environmental Pathogen
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Abuse hx
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Abuse Comments
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Sexual Hx
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Sexual hx Comments
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Legal hx?
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Legal hx comments
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Any substance use?
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Caffeine
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Caffeine comments
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Tobacco
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Tobacco
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Tobacco comments
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Alcohol
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Alcohol comments
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Other drugs
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Other drugs free text
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Drug of choice
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First use
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Last use
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Heaviest use
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