Headache History
Head and Neck: Any eye disease, faulty sight or eye pain Yes_____ Any ear disease or impaired hearing Yes Any trouble with nose, sinuses, mouth or throat Yes Trouble swallowing Yes Hard lumps on tongue, lips or mouth Yes Glaucoma Yes_____ Cardiovascular: Chronic/frequent cough, chest pain, angina Yes Spitting up of blood Yes Nightsweats, chills ... ................
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