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Past Medial History
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Allergies
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Cardiac PMH
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Kidney PMH
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Risks/Benefits Reviewed and questions answered
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Medication
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New Short Text Field
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New Yes / No
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Vitamin Injection
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Adverse Events with previous injection
• • •
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IM Injection
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IM Needle
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IM injection site
• • •
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Injection Frequency
• • •
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Complications
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Injection completed by
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Additional Notes
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Conversation Notes
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