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Reason for visit
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Current medication or supplements:
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Current allergies:
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Medical history:
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Medical History Notes:
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Family History:
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Family History Notes
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Deceased Family Members:
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Consult regarding Semaglutide?
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Current weight:
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Goal weight:
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Starting semaglutide dose (If applies):
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Pregnant or planned pregnancy?
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Breastfeeding?
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Has children?
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Patient has labs done?
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Labs to be ordered
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Lab Notes:
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Education provided
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Assement for treatment
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Assesment notes:
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Consent form signed?
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Care plan:
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Other care plan notes:
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