Review Of Systems

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Review of Systems

Enter only positive symptoms patient has had in last 2 weeks.

Health
When was your last tetnus shot?:
When was your last Pneumonia shot?:
When was your last Flu shot?:
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Date of last Pap Smear:
Date of last Mammogram:
Date of last Bone Density Scan:
Have you ever had an abnormal Pap Smear:
Have you ever had an abnormal Mammogram:
Date of Last PSA:
How many packs of cigarettes do you smoke per day:
How many years have you smoked:
How much alcohol do you drink a week:
If you use recreational drugs, please give us a list:
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