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Medical History -->
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*Tap Here (Medical History)
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* - Past Medical History:
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Tap Here (Past MH)
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- Past MH Comments:
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Tap Here (Past MH Comments)
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* - Past Surgical History:
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Tap Here (Past SH)
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- Past SHx Comments:
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Tap Here (Past SH Comments)
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- Childhood Immunization:
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Tap Here (Childhood Immunizations)
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- Childhood Imm. Comments:
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Tap Here (CI Comments)
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Family History -->
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*Tap Here (Family History)
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- Father (Alive/Deceased)
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Tap Here (Alive)
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- Father's Medical History:
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Tap Here (Father's MH)
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- Father MH Comments:
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Tap Here (Father MH Comments)
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- Mother (Alive/Deceased)
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Tap Here (Alive)
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- Mother's Medical History:
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Tap Here (Mother's MH)
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- Mother MH Comments:
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Tap Here (Mother MH Comments)
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- Brother(s) Total:
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Tap Here (Brother's Total)
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- Sister(s) Total:
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Tap Here (Sister's Total)
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- Sibling Medical History:
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Tap Here (Sibling MH)
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- Sibling MH Comments:
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- Son(s) Total:
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Tap Here (Son's Total)
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- Daughter(s) Total:
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Tap Here (Daughter's Total)
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- Children Medical History:
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Tap Here (Children MH)
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- Children MH Comments:
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Tap Here (Children MH Comments)
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Social History -->
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*Social History
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- Martial Status:
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Tap Here (Marital Status)
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- Occupation:
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Tap Here (Occupation)
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* - Sexual History:
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Tap Here (Sexual Hx)
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- Sexual History Comments:
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- Living Arrangement:
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- Living Arrangement Comments:
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- Alcohol:
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*Tap Here (Alcohol)
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- Other Substances:
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*Tap Here (Other substances)
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