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HEALTH HISTORY QUESTIONNAIRE Your Current Health Complaint What are your goals/expectations for your health care journey with me?How long has your main complaint been bothering you? ___ Is your current
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Begin by writing down your symptoms in detail.
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Include any relevant medical history or pre-existing conditions.
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Note any medications you are currently taking.
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Describe the duration and severity of your symptoms.
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Include any recent changes in lifestyle or habits that may be impacting your health.

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Anyone seeking medical advice or treatment for their health complaint.
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Healthcare providers who need detailed information to make an accurate diagnosis.
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I am currently experiencing severe headaches and fatigue.
I am required to file my own health complaint.
To fill out my health complaint, I need to provide details about my symptoms, medical history, and any treatments I have tried.
The purpose of my health complaint is to document my symptoms and seek medical advice for treatment.
I must report details such as the onset of symptoms, severity, duration, any triggers, and any previous medical conditions.
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