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PAST MEDICAL HISTORY
Do you now or have you ever had: DiabetesHigh blood pressureHigh cholesterolHypothyroidismGoiterCancerLeukemiaPsoriasisAnginaHeart problemsHeart murmurPneumoniaPulmonary embolismAsthmaEmphysemaStrokeEpilepsy(seizures)CataractsKidney diseaseKidney stonesCrohn’s diseaseColitisAnemiaJaundiceHepatitisStomach/Peptic ulcerRheumatic feverTuberculosisHIV/AIDSOther...
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