The United States Social Security Administration

FULL NAME: _____ REASON FOR VISIT : ... Details. No significant past medical history. INFECTIOUS DISEASE. AUTOIMMUNE. Lyme Disease. Lupus. Hepatitis. Sjogren’s Disease. History of MRSA Infection. Rheumatoid Arthritis. HIV/AIDS. ... Peripheral Vascular Disease. Peripheral Neuropathy. Varicose Veins (Venous Insufficiency) ... ................
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