Energy level – at what time of day is it……
Pain / pressure in chest. Palpitations . Persistent cough. Coughing blood. ... Burning / belching / acid reflux. Stomach pain/cramps. Nausea. Vomiting. Bad breath. Sores in mouth. Weight gain. Weight loss. Bitter / sour taste in mouth. Abdominal bloating. Other _____ Women only: Are you or do you think you are pregnant? Y / N. ................
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