Review of Systems Template 1Review of Systems Template 1
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REVIEW OF SYSTEMS
First Name

GENERAL
Fatigue
Fever
Weakness
Weight Loss
EARS
Hearing Loss
Earache
Discharge
Ringing
THROAT
Soreness
Swallowing
Infections
SKIN
Rashes
Itching
Dryness
Mole Changes
Sores
CHEST
Short Breath
Cough
Chest Pain
Wheezing
HEART
Cold Extremity
Ankle Edema
Murmur
Varicosity
Blood Clots
Palpitations
GENITOURIN
Urine Hesitancy
Incontinance
Urgency
Frequency
Kidney Stones
WOMAN
Painful Sex
Discharge
Irreg Periods
Hot Flashes
Loss of Libido

Initial

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AURORA
14707 E. 2nd AVE., STE. 260
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