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Patient Details
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Patient ID
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Screening
2 / 5
Presenting Complaint
History of Presenting
ODQ
Disease
Medical Histroy
Family History
Hypertension
Diabetes Melitus
Bronchial
Coronary Artery Disease
Epilepsy
Stroke
Kidney Failure
Sickle Cell Disease
PUD
Cancer
Others
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Screening
3 / 5
Surgical History (if applicable)
Gynecological and Obstetric History (if applicable)
Social History
Respiratory System
Cough
Sputum
Shortness of breath
Hemoptysis
Muscle Ache
Respiratory System
Others
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Screening
4 / 5
Gastro Intestinal
Vomiting
Diarrhea
Hematemesis
Melena
Abdominal Pain
Others
Genito Urinary System
Frequency
Dysuria
Hematuria
Urgency
Poor Urine Stream
Others
Nervous System
Headache
Paresis
Muscle Weakness
Seizures
Incoherent
Vertigo
Memory Loss
Others
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Screening
5 / 5
Working Diagnosis
Treatment / Management
Final Advice
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