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- AK Fracture & Orthopedic Clinic Medical History Form 2019
Get AK Fracture & Orthopedic Clinic Medical History Form 2019-2024
Send Today s Note: Occupation: Left / Right Handed Work injury? Yes / Yes / No No Date of Injury: Current Complaint Chief Complaint: When did the problem start? Left / Right How did it start? Made better or worse by: The body part is: Painful Yes / No Weak Yes / No Stiff Yes / No Swollen Yes / No Numb Yes / No Any imaging (X-rays, MRI, CT)? Where and when done? Additional info on current injury/problem: CURRENT MEDICATIONS Please list ALL medi.
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