HISTORY? STABLE? NO NO YES YES
H VaIvular Heart Disease Pulmonary Disease I Diabetes Mellitus Bleeding Diathesis S Renal Disease Hepatic Disease T Other Medical Condition(s) Surgical History 0 Relevant Family/ Social History R Last Menses Tobacco ETOH Drug (If Applicable) Use Use Use M E D I C A T I 0 N S Y D O S E S & P B.P. H Y S I C A L NORMAL ABNORMAL DESCRIBE ABNORMAL ... ................
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