Paternal grandma- died at 78, pneumonia. Paternal grandpa- died at 85 Sister- DM 2, HTN 52 years of age Brother: died at 24 in MVA. Daughter asthma, 19 years old Review of Systems (ROS): Address all body systems that may help rule in or out a differential diagnosis Check the box next to each positive symptom and provide additional details. Constitutional Skin HEENT ☐ Fatigue Click or tap here to enter text. ☐ Weakness Click or tap here to enter text. ☐ Fever/Chills Click or tap here to enter text. ☒ Weight Gain15-20 lbs in two years ☐ Weight Loss Click or tap here to enter text. ☐ Itching Click or tap here to enter text. ☐ Rashes Click or tap here to enter text. ☐ Nail Changes Click or tap here to enter text. ☐ Skin Color Changes Click or tap here to enter text. ☐ Diplopia Click or tap here to enter text. ☐ Eye Pain Click or tap here to enter text. ☐ Eye redness Click or tap here to enter text. ☐ Vision changes Click or tap here to enter text. ☐ Photophobia Click or tap here to enter text. ☐ Earache Click or tap here to enter text. ☐ Tinnitus Click or tap here to enter text. ☐ Epistaxis Click or tap here to enter text. ☐ Vertigo Click or tap here to enter text. ☐ Hearing Changes Click or tap here to enter text. ☐ Hoarseness Click or tap here to enter text. ☐ Oral Ulcers Click or tap here to enter text. ☐ Sore Throat Click or tap here to enter text. ☐ Congestion Click or tap here to enter text. ☐ Rhinorrhea Click or tap here to enter text.

☐ Trouble Sleeping Click or tap here to enter text. ☐ Night Sweats Click or tap here to enter text. ☐ Other: Click or tap here to enter text. ☐ Other: Click or tap here to enter text. ☐ Eye discharge Click or tap here to enter text. ☐ Other: Click or tap here to enter text. Respiratory Neuro Cardiovascular ☐ Cough Click or tap here to enter text. ☐ Hemoptysis Click or tap here to enter text. ☐ Dyspnea Click or tap here to enter text. ☐ Wheezing Click or tap here to enter text. ☐ Pain on Inspiration Click or tap here to enter text. ☐ Sputum Production Choose an item. Choose an item. Choose an item. ☐ Other: Click or tap here to enter text. ☐ Syncope or Lightheadedness Click or tap here to enter text. ☐ Headache Click or tap here to enter text. ☐ Numbness Click or tap here to enter text. ☐ Tingling Click or tap here to enter text. ☐ Sensation Changes Choose an item. ☐ Speech Deficits Click or tap here to enter text. ☐ Other: Click or tap here to enter text. ☒ Chest pain midsternal chest pain/chest tightness onset last month non radiating. worsening with exertion.multiple episodes with each episode lasting only a few minutes ☐ SOB denies . ☐ Exercise Intolerance has not done any exercise ☐ Orthopnea Click or tap here to enter text. ☐ Edema Click or tap here to enter text. ☐ Murmurs Click or tap here to enter text. ☐ Palpitations denies ☐ Faintness Click or tap here to enter text. ☐ OC Changes Click or tap here to enter text. ☐ Claudications Click or tap here to enter text.