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What is the problem?
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Location
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Location Comments
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Timing (how long)
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Timing comments
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Onset
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Onset comments
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Severity
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Severity Comments
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Quality
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Quality Comments
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Duration
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Duration 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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Associated Symptoms
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Associated Symptoms Comments
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Previous Treatment
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Specific education(plan)
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Free Text
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Free Text
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ROS:
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General [-]
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General [+]
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General Comments
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Skin [-]
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Skin [+]
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Skin Comments
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HEENT [-]
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HEENT [+]
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HEENT Comments
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Neck [-]
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Neck [+]
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Neck Comments
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Breasts [-]
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Breasts [+]
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Breasts Comments
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Cardiovascular [-]
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Cardiovascular [+]
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CV Comments
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Respiratory [-]
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Respiratory [+]
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Resp Comments
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GI [-]
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GI [+]
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GI Comments
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Urinary [-]
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Urinary [+]
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Urinary Comments
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Genital (Male) [-]
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Genital (Male) [+]
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Genital (Male) Comments
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Genital (Female) [-]
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Genital (Female) [+]
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Genital (Female) Comments
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Periph. Vasc. [-]
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Periph. Vasc. [+]
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Periph. Vasc. Comments
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MSK [-]
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MSK [+]
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MSK Comments
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Neurologic [-]
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Neurologic [+]
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Neuro Comments
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Endocrine [-]
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Endocrine [+]
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Endo Comments
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Psychiatric [-]
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Psychiatric [+]
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Psychiatric Comments
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