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MEDICAL HISTORY Name: Age: DOB: Type of cancer: Date of diagnosis: Oncologist: Radiation Oncologist: Specific location: (Left/Right Breast) Presenting Symptoms (symptoms that led to diagnosis: fatigue,

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Symptoms are signs or indications of a specific medical condition or illness.

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Medical professionals or individuals experiencing health issues are required to report symptoms.

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Information such as the type of symptoms, their severity, any triggers or patterns, and any previous medical history related to the symptoms should be reported.

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