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Name:

Location:

Admit:

HH#:
ID:

CC:

HPI:

PSH:

FH:

SH:

Contact:
PMD:
Allergies:
PMH:

HR

RR

BP

O2sat

Meds (outpt)

Wt:
PE:
gen

HEENT

neck

chest

heart

back

lungs

abd

GU

rectal

extr

skin

neuro

CCL

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