• Patient Review of Systems

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  • ARE YOU CURRENTLY EXPERIENCING ANY OF THE FOLLOWING:

  • General
  • Eyes and Vision

  • Ears, nose, throat and mouth
  • Heart trouble

  • Breathing trouble

  • Stomach trouble

  • Joint trouble
  • Neurologic trouble

  • Hormone trouble

  • Bleeding trouble

  • Urination trouble

  • Women

  • Men

  • Clear
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  • Should be Empty: