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Medical History
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Past Medical History:
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Past Medical History Freewrite
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Past Surgical History
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Surgeries
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Social History
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Current Day Smoker -
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Vaping
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Number of packs per day
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Number of Years Smoking
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Alcohol Consumption -
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Alcohol Beverage
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Quantity of Alcohol
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Family History
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New Free Draw
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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)' Brother(s)
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Brother Siblings
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Sibling(s)' Sister(s)
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Sisters Siblings
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Maternal Grandmother
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Maternal Grandmother
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Maternal Grandfather
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Maternal Grandfather
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Paternal Grandmother
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Paternal Grandmother
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Paternal Grandfather
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Paternal Grandfather
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Grandparent's MH
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Comments
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Children(s)' MH
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Comments
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Social Status
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Comments
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Vaccinations
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Comments
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