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Review of Systems: (Please check all that currently apply)
CONSITUTIONAL
Fever
Chills
Feeling Poorly
Feeling Tired
Recent Weight Gain
Recent Weight Loss
EYES
Eye Pain
Wearing Glasses
Spots Before My Eyes
Vision Challenges
Dry Eyes
Itchy Eyes
EARS/NOSE/THROAT
Earaches
Loss Of Hearing
Nose Bleeds
Sinus Problems
Sore Throat
Dental Problems
CARDIOVASCULAR
Chest Pain
Palpitation
Fast Heart Rate
Slow Heart Rate
Legs Swelling-Edema
RESPIRATORY
Shortness Of Breath (SOB)
Respiratory Distress In Sleep
SOB When Lying Flat
Wheezing
Cough
SOB On Exertion
GASTROINTESTINAL
Abdominal Pain
Vomiting
Nausea
Constipation
Diarrhea
Maroon Colored Stool
Heartburn
Black Stool
OBGYN/GU
Abnormal Bleeding
Irregular Menses
Pain With Menses
Pain With Sex
Decreased Libido
Vulvar Itching
Midcycle Bleeding
Bleeding After Sex
Vulvar Pain
Vaginal Itching
Pelvic Pain
Vaginal Dryness
Vaginal Odor
MUSCULOSKELETAL
Joint Pain
Limb Pain
Joint Swelling
Limb Swelling
Joint Stiffness
INTEGUMENTARY(SKIN)
Acne
Breast Discharge
Itching
Change In A Mole
Breast Pain
Breast Lump
NEUROLOGICAL
Confused
Memory Problem
Dizziness
Headache/Migraines
Limb Weakness
Difficulty Walking
PSYCHIATRIC
Suicidal
Change In Personality
Anxiety
Sleep Disturbance
Depression
Emotional Issues
ENDOCRINE
Hair Loss
Hot Flashes
Heat/Cold Intolerance
Muscle Weakness
Deepening Of The Voice
Feeling Weak
Dry Skin
HEMATOLOGY/IMMUNOLOGY
Easy Bleeding
Seasonal Allergies
Swollen Glands
Easy Bruising
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