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7oF or 38oC Pneumonia in the prior 4 weeks Past Medical / Surgical History circle if the patient has or has had Asthma/Reactive Airway Disease GERD Congenital heart disease Heart murmur Prematurity weeks Family History/Psychosocial Assessment Allergies/Reactions Yes No Bleeding Disorders / Tendencies Yes Family h/o anesthesia problems Yes No No If Yes to above describe Immunizations Up To Date Yes No Date of Last Menstrual Period N/A Current Medications PLEASE TURN OVER Hnp HNP Revised Jan....
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