University of Phoenix
Health/ Safety/ Risk Medical Current History Medical Current History Asthma Y N Y N Diabetes Y N Y N Frequent Colds Y N Y N Pneumonia Y N Y N Respiratory/Lung/ Breathing Problems Y N Y N Uses Catheter, colostomy Y N Y N Feeding Issues Y N Y N GER (gastro esophageal reflux) Y N Y N At risk for Aspiration Y N Y N Allergies (Medication, Food ... ................
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