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Introduction - Exec exam
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Type of visit
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Occupation
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Employed
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Medical History
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Previous wellness visit with us
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Date and Dr of last visit if with us
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Health at last visit if with us
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Weight at last visit if with us
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BMI last wellness visit if with us
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Summary of significant previous vitals, exam, labs, etc
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State of overall health
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Recent Health changes
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Serious illness
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Injuries
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Hospitalizations
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Hospitalization details
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Significant Medication details
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Blood donation
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Comments/other
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List potential Environmental exposures
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Comments/other
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UTD health screenings
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Comments
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PCP's name
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if no PCP, sees other?
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