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Which provider
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Any new meds since last visit
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Yes List New Medications
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Any new allergies
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If Yes List New Allergies
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Weight
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Total Weight Loss
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BMI/FAT %
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Any undesirable side effects from meds
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History of Thyroid Cancer
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Neck Pain/ tenderness or masses
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History of liver or gallbladder disease
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history of pancreatitis
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MD/NP signature
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