Epilepsy or seizures y n fainting y n headaches

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Unformatted text preview: Joint(s) (hip/knee) Y N Asthma Y N Bleeding Abnormally with Extraction Y N Blood Disease Y N Cardiac Pacemaker Y N Cancer / Chemotherapy / Radiation Treatment Y N Congenital Heart Defect Y N Contact Lenses Y N Cough (Chronic) Y N Cold Sores/Fever Blisters Y N Diabetes Y N Emphysema Y N Environmental Allergies Y N Epilepsy or Seizures Y N Fainting Y N Headaches (Frequent) Y N Hearing Concerns Y N Heart Attack History Y N Heart Disease/Angina Y N Heart Murmur Y N Heart Surgery Y N Heart Valve Defect Y N Hemophilia/Blood Transfusion Y N Hepatitis (A, B, C) / Liver Disease Y N High Blood Pressure Y N HIV+ / AIDS Y N Kidney Disease Y N Low Blood Pressure Y N Lupus Y N Mitral Valve Prolapse Y N Nervous/Anxious Y N Pre- Medication (Antibiotic before Dental) Y N Psychiatric Care Y N Respiratory Disease Y N Rheumatic/Scarlet Fever Y N Chicken Pox/Shingles Y N Sexually Transmitted Disease Y N Shortness of Breath Y N Sickle Cell Disease Y N Sinusitis Y N Smoke or use tobacco Y N Stroke Y N Thyroid Disease Y N Tuberculosis PATIENT DENTAL HISTORY Do you currently have or have you had...
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This note was uploaded on 01/28/2014 for the course ITMG 321 taught by Professor Krueller during the Fall '11 term at American Public University.

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