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Patient Name: Date of Birth: Constitutional Symptoms Chills Y Neurologic Dizzy Spells Eyes GlaucomaGastrointestinal Constipation Diarrhea N Y NY FEMALE ONLY 1. Do you leak urine (have accidents)?
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To fill out constitutional symptoms, follow the steps below:
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Start by observing the patient and noting down any physical symptoms that are present.
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Ask the patient about any general feelings of discomfort, such as fatigue, weakness, or malaise.
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Inquire about any changes in appetite, weight, or sleep patterns.
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Document any fevers, night sweats, or chills experienced by the patient.
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Note down any changes in mood, such as irritability, anxiety, or depression.
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Ask the patient about any pain or discomfort in specific areas of the body.
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Record any other relevant symptoms that the patient may be experiencing.
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Finally, review the collected symptoms and organize them according to their relevance and significance.
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Use the filled-out constitutional symptoms to assist in diagnosis and treatment planning.

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- Patients: They can keep track of their own constitutional symptoms to provide more accurate information to healthcare providers.
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Constitutional symptoms refer to symptoms that affect the entire body, such as fever, fatigue, weight loss, and night sweats.
Individuals who are experiencing constitutional symptoms are required to file them with their healthcare provider.
To fill out constitutional symptoms, individuals should provide detailed information about the symptoms they are experiencing, including when they started and any factors that may have triggered them.
The purpose of reporting constitutional symptoms is to help healthcare providers diagnose and treat underlying medical conditions.
Information such as the type of symptoms, their duration, severity, and any associated factors should be reported on constitutional symptoms.
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