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General Questionnaire.
(Use this questionnaire if the specific medical
problem cannot be found in the following index) |
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A history of diabetes? |
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A history of coronary angioplasty? [DEMO] |
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A history ofemphysema (COPD) |
|
A history of coronary bypass surgery (CABG)? |
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A history of asthma? |
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A history of angina? |
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A history of multiple sclerosis (MS)? |
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A history of heart murmur? |
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A history of Parkinson's disease? |
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A history of hypertension? |
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A history of Dementia/Alzheimer’s Disease? |
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A history of a heart attack? |
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A history of seizure disorder (epilepsy)? |
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A history of cardiac arrhythmia? |
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A history of abnormal liver enzymes? |
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A history of abdominal aortic aneurysm (AAA)? |
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A history of hepatitis C? |
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A history of TIA (transient ischemic attack
or near stroke)? |
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A history of rheumatoid arthritis (RA)? |
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A history of stroke (cerebral vascular
accident or CVA)? |
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A history of ulcerative colitis? |
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A history of prostate cancer? |
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A history of Crohn's disease? |
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A history of breast cancer? |
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A history of obesity? |
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A history of colon cancer? |
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A history of depression? |
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A history of melanoma? |
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A history of systemic lupus erythematosus (SLE)? |
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A history of cancer of the kidney? |
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A history of osteoporosis? |
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A history of testicular cancer? |
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A history of sleep apnea? |
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A history of thyroid cancer? |
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A history of substance abuse? |
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A history of bladder cancer? |
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A history of claudication? |
