| Document Date: 2015-02-01 11:38:49
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City Tampa / Sarasota / / Company Yes Limited / / Facility Hospital USF Urogynecology / / / IndustryTerm energy / / MedicalCondition Asthma Uterine cancer High Blood Pressure Stroke Heart murmur Ovarian cancer Diabetes Blood clots / Cystocele / overactive bladder / Ovarian cancer / No Miscarriages / urge incontinence / cancer COPD Pulmonary embolism Lupus Bladder cancer Cancer / Urinary Incontinence / drug allergies / Heart disease / fecal incontinence / coughing / Muscle pain / Breast pain / Depression Anxiety Memory loss / Rectocele / Colon cancer / pain / dyspareunia / diseases / Eye pain / Serious injuries / Breast cancer / Back pain / sexually transmitted diseases / / MedicalTreatment Appendectomy / birth control / incision / Bowel surgery / Hysterectomy / vasectomy / surgeries / Abdominal surgeries / surgery / radiation / / / Position Physician / urine Patient signature Date Physician / / Product Medication Reaction F. Medications Medication / Provera / E. Allergies Medication / / ProgrammingLanguage FL / / ProvinceOrState Florida / / Technology radiation / cellular telephone / / URL www.usfurogyn.com / /
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Microsoft Word - 1-USF Urogyn new_patient_packet[removed]doc