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Medical History
Past Medical History
• • •
New Yes / No
Past Surgical History
• • •
New Yes / No
Social History
Caffeine
Comments
Alcohol
Comments
Other substances
New Yes / No

H&P Med / Fam / Social History Medical Form

Other

Pre-Hbot

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Published: May 19, 2025, 1:45 p.m.
Doctor: Dr. History Physical
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