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HEMORRHOIDS
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bulging from anal opening
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perianal itching
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perianal pain
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rectal bleeding
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other hemorrhoid related symptoms
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RECTAL PAIN
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rectal pain associated with
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rectal pain scale
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rectal pain character
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Proctalgia Fugax
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PERIANAL ITCHING
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perianal itching frequency
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Perianal itching severity
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BOWEL MOVEMENTS
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BM frequency
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BM Bristol Scale
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Blood in Stools
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Fecal Seepage/ Incontinence
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Fiber/ Laxative/ Supplements
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BM Comments
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BANDING FOLLOW UP
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did you have these symptoms post banding
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overall hemorrhoid symptoms since last banding
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OTHER
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REVIEW OF SYSTEMS
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General [-]
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General [+]
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General Comments
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Skin [-]
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Skin [+]
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Skin Comments
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GI [-]
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GI [+]
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GI Comments
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Urinary [-]
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Urinary [+]
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Urinary Comments
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Genital (Male) [-]
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Genital (Male) [+]
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Genital (Male) Comments
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Genital (Female) [-]
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Genital (Female) Comments
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Genital (Female) [+]
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MSK [-]
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MSK [+]
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MSK Comments
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Psychiatric [-]
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Psychiatric [+]
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Psychiatric Comments
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