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Briefly describe your primary pain complaint: Head Neck Shoulder Burning Numbness Tingling Right side Left side THE PAIN CENTER AT MEMORIAL − PATIENT QUESTIONNAIRE Hot Flashes Menstrual Cramps Excessive Menstruation Irregular Menses Lumps in Breasts ... Return Doc
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___ Hot Flashes ___ Hemorrhoids ___ Blood in Stool ___ Black Stools NEUROLOGIC ___ Other . HEAD AND NECK ___ Seizures . URINARY ___ Headaches ___ Blurred Vision ___ Dizzy Spells ___ Double Vision ___ Burning PAIN ___ Other ___ Shortness of Breath with Exertion ... Read Content
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___ Weight Gain ___ Heartburn ___ Back Pain ___ Weight Loss ___ Hot Flashes ___ Hemorrhoids ___ Blood in Stool ___ Black Stools NEUROLOGIC ___ Other HEAD AND NECK ___ Seizures URINARY ___ Headaches ___ Blurred Vision ___ Dizzy Spells ___ Double Vision ___ Burning ... Retrieve Here
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