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Medical History
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Current/Past Medical History
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Comments
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Hospitalizations In the Past Year
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Comments
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Past Surgery/Procedure
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Comments
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Adult Immunizations
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Comments
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Providers
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Date of last PE
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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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Social History
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Marital Status
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Comments
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Living Arrangements
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Comments
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Occupation
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Caffeine
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Comments
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Alcohol
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Comments
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Illicit substances
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Patient's Diet/Fluids
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