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Patient Signature guardian if under 18 Date Review of Systems Have you had any of the following pulmonary lung-related issues Asthma/difficulty breathing COPD Emphysema Other None of the above Heart surgeries Congestive heart failure Murmurs or valvular disease Heart attacks/MIs Heart disease/problems Hypertension Pacemaker Angina/chest pain Irregular heartbeat Other None of the above Visual changes/loss of vision One-sided weakness of face or body History of seizures One-sided decreased...

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