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Get DuPage Medical Group Adult Case History Form

D any of the following: Heart disease Mumps Kidney or renal problems Stroke/TIA Meningitis Chronic sinus infections Diabetes Measles Environmental allergies High blood pressure Scarlet fever Cancer Hypothyroidism HIV/AIDS Radiation/chemotherapy Asthma Tuberculosis Long term IV antibiotics Mental illness Visual Problems Head trauma Depression or anxiety Hepatitis A, B or C Loss of Consciousness Mig.

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