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Here/when? 4. Smoke cigarettes. If yes, how many per day? 5. Alcohol use. If yes, how many drinks/week? 6. Birth defects or genetic problems 7. Are you being treated for any illness/condition now? If yes, what? 8. Do you currently take medicine: prescription over the counter herbal? If yes, name: A. REVIEW OF SYSTEMS (cont.) YES NO ENDOCRINE 46. Thyroid problems 47. Diabetes HEMATOLOGICAL/LYMPHATIC 48. Anemia 49. Sickle cell disease/trait 50. Blood clotting disorder ALLERGY/IMMUNOLO.

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