MaritalStatus: MarriedSingle
Dependence on: AlcoholDrugsSmokingCoffee/TeaOther Substances/Medication
Any Past History: Hypertension (high B.P.)DiabetesAllergySurgeryOthers
Planning for Pregnancy in next 6 Months: YesNo
Duration of the complaint:
Photo:
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Gender: MaleFemale
Are you a Vegetarian: YesNO
Functional history: AppetiteAcidityGasMotionUrination – day/nightSleep – day/nightDiet - veg/non vegLifestyle – daily general routineOthers
Blood group:
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