PATIENT HISTORY FORM - Hopkins Medicine
**Fever or chills >3 days Flu-like symptoms Headaches (chronic) **Jaundice (yellow skin/eyes) Joint pain (chronic)- PZA **Light colored stools **Loss of appetite **Malaise/fatigue **Nausea/vomiting **Numbness/tingling **Skin rashes/itching **Sores on lips or inside mouth **Unusual bleeding (nose, gums, stool, urine, etc. or easy bruising)-RIF ... ................
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