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Onset
• • •
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Onset Comment
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Quality of CC
• • •
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quality location
• • •
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Quality location comment
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Severity Average
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Severity Max
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Severity max "which occurs while
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Frequency
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frequency comment
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Chronology
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chronology comment
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Duration of the CC is reported..
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Increases Symtpoms
• • •
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Other:
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Decrease symptoms
• • •
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Other:
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Associated Symptoms
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Associated Symptoms Comments
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PSFS
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PSFS comment
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Prior treatment "prior care"
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Other current problems
• • •
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Other current problem comment
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line drawing
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Line Drawing Key
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