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Medical History
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patient Past Medical History
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Past Medical History comments
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Past Surgical History
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Comments
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Allergy
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Comments
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PCP
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PCP Contact Information
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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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Siblings MH
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Siblings MH
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Grandparent's MH
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Children(s)' MH
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number of childern
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grandkids
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Social History
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Marital Status
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Occupation
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Tobacco
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hours worked weekly
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Caffeine
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Comments
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Other Substances
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Comments
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stress management
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Comments
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hobbies
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Comments
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pets
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spiritual
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