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Loss/wt. gain Liver Disease Hx. Ulcers Heartburn Reflux Diarrhea Constipation Ostomy ENDOCRINE Steroid use Other Diabetic Yes No Thyroid Disorder Yes No dates Yes No explain RESPIRATORY Asthma COPD Emphysema Shortness of Breath Yes No Cough Secretions Snoring Sleep Apnea Airway Obstruction Yes No Hx. Of Infections Dialysis Catheter Hx. Of Kidney Stones NEURO Dizziness Headaches Stroke Fainting Numbness Paralysis Multiple Sclerosis Paraplegia SKIN Sores Rashes INFECTIOUS DISEASE Back pain...
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Rev 1115 is a tax form used for reporting certain information to the IRS.
Individuals or businesses that meet specific criteria set by the IRS are required to file rev 1115.
Rev 1115 can be filled out manually or electronically, following the instructions provided by the IRS.
The purpose of rev 1115 is to report relevant financial information to the IRS for tax purposes.
Rev 1115 requires reporting of income, deductions, credits, and other financial details as specified by the IRS.
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