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Patient Name Birthdate Review of Systems (Please check all that apply)ConstitutionalRespiratorySkin Fever/chills Excess weight loss/gain Loss of appetite Cough Wheezing Chest tightness Rash Diaper
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What is excess weight lossgain?
Excess weight loss/gain is the difference between the current weight of an individual and their ideal weight.
Who is required to file excess weight lossgain?
Individuals who are tracking their weight loss or gain progress may be required to file excess weight loss/gain.
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Excess weight loss/gain can be filled out by recording your current weight and ideal weight, then calculating the difference.
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The purpose of excess weight loss/gain is to track progress and monitor changes in weight over time.
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