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Type of Facility
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Source of Information
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Reason for Visit
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History of Present Illness
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Chief Complaint
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Location
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Location Comments
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Quality
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Quality Comments
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Severity
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Severity Comments
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Duration
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Duration Comments
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Onset / Timing
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Onset Comments
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Context
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Context Comments
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Modifying Factors
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Modifying Factors Comments
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Depression
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Depression
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Anxiety
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Anxiety
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Mania
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Mania
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Cognitive Impairment
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Cognitive Impairment
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Psychosis
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Psychosis
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Behavioral disturbances
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Behavioral disturbances
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Attention-deficit/hyperactivity disorde
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Attention-deficit/hyperactivity disorder
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Associated Symptoms Comments
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Status of 3 Chronic Conditions
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