Patient Intake Form example
Please list all current medications, including supplements and over-the-counter medications: ... Normal Cough Asthma Lung Cancer TB Pneumonia COPD Gastrointestinal: Normal Stomach Ulcer Diarrhea Constipation Acid Reflux Cancer Indigestion Vomiting Hepatitis GI Bleeding Genito-Urinary: Normal Urine Retention Blood in Urine Frequent Urination Sexual Dysfunction Incontinence Musculoskeletal ... ................
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