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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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Previous PCP / Last Seen?
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Female Health
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Last Pap-Smear - (Date/Location)
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Mammogram - (Date/Location)
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Colonoscopy - (Date/location)
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Bone Density - (Date/Location)
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Pregnancies hx
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Male Health
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Colonoscopy hx
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Difficulty Urinating?
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Difficulty urinating comments
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