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Mark your areas of pain.
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Chief Complaint #1
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How is Chief Complaint #1 doing?
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Chief Complaint #2
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How is Chief Complaint #2 doing?
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Pain Scale (0 - 10)
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Frequency
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Quality
• • •
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Any Other Pertinent Medical History:
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What makes your condition better?
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What makes your condition worse?
• • •
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Do you have any new injuries?
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What is your new injury?
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