| 
               Medical Illness 
  
  
  • • •
  
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               Medical illness comment 
  
  
  
  
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| 
               Social History 
  
  
  • • •
  
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               Social History Comment 
  
  
  
  
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| 
               Past Surgical History 
  
  
  • • •
  
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               Past Surgeries Comment 
  
  
  
  
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| 
               Family Medical History 
  
  
  • • •
  
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               Family History Free Text 
  
  
  
  
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