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Medical History
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Past Medical History
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Past Medical History Comments
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Hospitalization History:
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Past Surgical History:
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Past Surgical History Comments
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Immunization Status:
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Immunization Comments:
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Gyne History:
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Gynecologic history
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Comments: (Other)
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Family History
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Unremarkable
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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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Children(s)' MH
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Comments
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Social History
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Marital Status
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Marital Status Comments:
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Living Arrangements
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Living Arrangement Comments:
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Previous Occupation:
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Occupation; free text
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Alcohol Use
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Alcohol use comments:
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Tobacco
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Comments
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DNR
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POA
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Caregiver/Home Health Agency
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Current Services
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