PATIENT HISTORY FORM - Hopkins Medicine
( Recent weight gain; how much____ ( Frequent sore throats ( Anemia ( Recent weight loss: how much____ ( Hoarseness ( Bleeding tendency ( Fatigue ( Difficulty in swallowing ( Weakness ( Pain in jaw while chewing SKIN ( Fever ( Easy bruising ( Night sweats. NECK ( Redness ( Swollen glands ( Rash Muscle/Joints/Bones ................
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