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Get Greenville Hospital System Inpatient History & Physical Form

Int/Reason for Consult: Allergies: History of Present Illness: Medications and Dosages: Past Medical/Surgical History: AGE: ROOM#: Social History: Family History: Page 1 of 4 Patient Stamp Comprehensive Review of Systems ROS NOT OBTAINABLE BECAUSE Constitutional: YES NO DESCRIBE Fever, sweats or chills Fatigue, anorexia, weight loss or gain Weakness Genitourinary: YES NO DESCRIBE Dysuria, frequency or urgency Menstrual irregularities LMP ___________________ Frequent UTI’s Pain/.

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