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Medical History
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Cardiovascular
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Cardiovascular
• • •
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Cardiovascular History Freewrite
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HEENT
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HEENT history
• • •
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HEENT History Freewrite
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Psychiatric
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Psychiatric history
• • •
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Psychiatric History Freewrite
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Gastroenterology
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GI History
• • •
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GI History Freewrite
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Pulmonary
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Pulmonary history
• • •
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Pulmonary History Freewrite
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Musculoskeletal
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Musculoskeletal history
• • •
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Musculoskeletal History Freewrite
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GU/Renal
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GU/Renal
• • •
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GU/Renal History Freewrite
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Neurologic
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Neurologic history
• • •
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Neurologic History Freewrite
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Endocrine
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Endocrine History
• • •
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Endocrine History Freewrite
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Integumentary
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Integumentary History
• • •
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Integumentary History Freewrite
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Hematology/Oncology
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Hematology/Oncology History
• • •
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Hematology/Oncology History Freewrite
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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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Surgical History
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Past Surgical History
• • •
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Surgical history freewrite
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History of malignant hyperthermia
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Date of last PE
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PCP
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PCP Contact Information
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Family History
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Father's MH
• • •
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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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Children(s)' MH
• • •
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Comments
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Grandparent's MH
• • •
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Comments
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Other relevant family medical history
• • •
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Comments
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Social History
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Tobacco use
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Pack-years
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Living Arrangements
• • •
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Alcohol
• • •
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Comments
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Recreational drug use
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Comments
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Caffeine
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Comments
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Marital Status
• • •
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Comments
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Sexual hx:
• • •
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Comments
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Occupation
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Potential Environmental Pathogen
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Patient's diet
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Health Maintenance
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Mammogram
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Last mammogram
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Pap/HPV:
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Pap result
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Date:
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Next pap screening due:
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Bone density
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DEXA results:
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Date:
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Next DEXA due:
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Colon cancer screening
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Colonoscopy findings
• • •
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Date:
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Next colonoscopy due:
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Other colon CA screening methods:
• • •
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