Norway pharmacy online: Kjøp av viagra uten resept i Norge på nett.

Jeg har selv prøvd dette kamagra Det er billig og fungerer egentlig, jeg likte det) kjøp kamagra Ikke prøvd, men du kan eksperimentere med... Hvordan føler du deg, følsomhet etter konsumere piller?.

Microsoft word - patient history form (04-07-11).doc

PATIENT HISTORY FORM FOR ARTHUR F. SMITH, MD NAME: ________________________________________________ AGE: ______ SEX M___ F ___ DATE: _____________ If you are on DIALYSIS, please notify the front desk immediately. (SOME MEDICARE POLICIES ONLY COVER DIALYSIS AND NOT DERMATOLOGY VISITS)

REASON FOR VISIT (MAIN PROBLEMS): CHECK GROWTHS FOR SKIN CANCER NEW GROWTH(S) OLD GROWTH(S) NEW RASH

WORSENING RASH PLEASE FINISH THIS PAGE. PLEASE FILL OUT RASH QUESTIONAIRE (NEXT PAGE) ONLY IF YOU ARE HERE FOR A RASH.
PLEASE EXPLAIN THE REASON FOR YOUR VISIT: ________________________________________________________________________________
____________________________________________________________________________________________________________________________

MEDICATION LIST: PLEASE LIST ALL YOUR MEDICATIONS INCLUDING ASPIRIN, VITAMINS, OVER THE COUNTER DRUGS, TOPICAL
MEDICATIONS AND EYEDROPS AND WHAT DISEASE THEY ARE TAKEN FOR. PCP _______________________________________

MEDICATION / PROBLEM BEING TREATED MEDICATION / PROBLEM BEING TREATED
___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________
___________________________________________________ ___________________________________________________
DO YOU TAKE COUMADIN, PLAVIX, ASPIRIN, VITAMIN E, ST JOHNS WART(CIRCLE)

ALLERGIES and REACTIONS to drugs or topical agents: Penicil in, Keflex, Sulfa, Tetracycline (CIRCLE) or other medications—if so, state which ones:
__________________________________________________________________________________________________________________________
VERY IMPORTANT TO FILL OUT PROBLEMS AND DISEASES: PLEASE CIRCLE ANY OF THE FOLLOWING THAT PERTAINS TO YOU:
Actinic keratoses / squamous cel / basal cell / melanoma / Psoriasis /Seborrheic dermatitis / Eczema / Acne / Contact dermatitis
AIDS Allergies Angina Arthritis (Type:_________) Asthma Artificial heart valves Artificial joints (hips knees) Cancer(Type:_______________)
Diabetes Heart Disease Heart mumur Heart Failure High Cholesterol/TG’s High Blood Pressure Inflammatory Bowel Disease
Hay Fever Hepatitis Kidney Disease Liver Disease Lung Disease Parkinson’s Stroke
Tuberculosis Ulcers Please LIST ALL OTHER MEDICAL ILLNESSES NOT IDENTIFIED ABOVE:________________________________________________________________ ______________________________________________________________________________________________________________________________ REVIEW  OF  SYSTEMS:  DO  YOU  HAVE  NOW,  OR  HAVE  YOU  HAD  DISEASES  OR  CONDITIONS  LISTED  BELOW?  PLEASE  CHECK.   IF  NOT  CIRCLED  ANSWER  IS  NO.  

_______________________________________________________________________________________________________________________
PAST MEDICAL, FAMILY, AND SOCIAL HISTORY:
Is there a Family History of any of the following? Melanoma Y/N Basal Cel Carcinoma Y/N Squamous cel carcinoma Y/N Eczema Y/N Psoriasis Y/N
Lupus Y/N Fungus Y/N
SOCIAL HISTORY: Please circle any of the significant exposures Past or Present: Smoking Drinking Occupation Golf Tennis Sports Gardening/Yard work
Beach Boating Swimming Fishing Walking Other
Hobbies:_____________________________________________________________________________________
Please list previous occupations or other significant SUN exposures:_______________________________________________________________________
PATIENT SIGNATURE___________________________________________________PHYSICIAN SIGNATURE____________________________________ PATIENT HISTORY FORM (04-07-11).doc 6/25/12 6:00 PM ARTHUR F. SMITH, M.D RASH QUESTIONAIRE
FOR PATIENTS WITH A RASH ONLY
FILL OUT THIS PAGE ONLY IF YOU HAVE A NEW RASH
Please give information regarding your present RASH OR RASHES: 1____________________________________________________________________________________________________________________________ 2_____________________________________________________________________________________________________________________________ 3_____________________________________________________________________________________________________________________________ PLEASE LIST ALLORAL AND TOPICAL MEDICATIONS AND LOTIONS YOU USED TO TREAT THIS RASH._________________________________ __________________________________________________________________________________________________________________________ 1. Location: (Please circle) scalp face ears neck chest abdomen back genitals groin buttocks legs feet nails hair 2. Duration: (How long have you had this problem?) _____days _____weeks _____months _____years 3. Signs (Does your rash have any: (Please circle) scratch marks/ purple marks/ pus/ blisters/ cracks / thick areas 4. Symptoms/Quality: (Please circle) itch pain burn tender swel ing ulcer other ________________ 5. Related signs and symptoms (Please circle): fever / flu like symptoms/ painful joints (arthralgias)/ sore throat/ none 6. Modifying factors: Medications or treatments that: helped __________________________ aggravated ___________________________________
7. Severity: (Please circle) mild / moderate/ severe 8. Context: Does problem relate to any activity or environmental factors (sun)? No ____Yes (please explain)_________________________________ 9. Timing: Does problem relate to work ,hobbies, housework, cleaning etc.____________________________________________________________ 10. Do you use any of the fol owing: Ponds/ Oil of Olay/ Eucerin/ Vaseline Intensive care/ vitamin E containing products/Neosporin/Bacitracin Triple antibiotic ointment/Topical Benadryl/ Caladryl / Lanacaine / Irish Spring/ Coast/ Safeguard / Lever 2000 Other cosmetics, moisturizers, soaps, toothpastes and anything else being applied to the skin. Everything is important to report.
PATIENT HISTORY FORM (04-07-11).doc 6/25/12 6:00 PM ARTHUR F. SMITH, M.D

Source: http://www.arthurfsmithmd.com/forms/AFSmithDermatology_PatientHistory.pdf

hef.nu

Humanist Manifesto 2000 Humanist Manifesto 2000 är utarbetat av Paul Kurtz, huvudredaktör för FREE INQUIRY, som också har tagit fram Humanistiskt manifest II (1973), En sekulär humanistisk deklaration (1980) och En deklaration om ömsesidigt beroende: en ny global etik (1988). Översättning till svenska är gjord av Lars Torstensson. Begreppen 'humanism' och 'humanist' avser här etisk s

Microsoft word - mrsa faq.doc

Community-Acquired Methicillin Resistant Staphylococcus aureus What is Staphylococcus aureus (staph)? Staphylococcus aureus , often referred to as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacter

Copyright © 2010-2014 Drug Shortages pdf