EVERGREEN HOSPITAL MEDICAL CENTER
Eyes ( ( ( Blurry vision even with glasses Breasts ( ( ( Double vision (diplopia) ( ( ( Lumps or discharge ... R L Both sides. Main level ( Parents. Is there an elevator? Y N. Split level? Y N ... ( No ( Yes If yes, please circle: Solids Liquids Both. Do you currently have any restrictions with what you can eat or drink? ( No ( Yes If yes ... ................
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