Rxpad - Texas Department of State Health Services
HEART & BLOOD VESSELS: NO PROBLEM (no history) High or low blood pressure (circle one) Known abnormal ECG. Congestive Heart Failure. Chest pain (angina) or pressure. Coronary artery disease. Heart attack or blockage: (date) _____ Heart murmur. Valve disorder. Mitral valve prolapse. Circulation problems. Heart arrhythmia ................
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