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At 07:37 PM 6/21/2001 -0700, you wrote:
>
>Email 6
>
>TO ANSWER SECTION E-2 CONDITIONS NOW:  CHECK ALL ITEMS THAT APPLY TO YOU
>FILL IN THE BLANKS.
>
>LIST ANY MEDICATIONS YOU MIGHT REMEMBER BEING GIVEN FOR ANY OF THE AILMENTS
>LISTED BELOW THAT ARE NOT YOUR CURRENT PD MEDICATIONS.
>
>
>Acid Reflux
>
>
>Acoustic Ceilings
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>Agent Orange
>
>
>Allergies
>
>
>Anemia
>
>
>Antidepressants
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>Anxiety
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>
>Arthritis
>
>
>Asbestos
>
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>Asthma
>
>
>Bacterial Infections
>
>
>Balance Problems
>
>
>Balance Problems:  Weaker Side Left
>
>
>Balance Problems:  Weaker Side Right
>
>
>Bouts of Excessively High Fever
>
>
>Bronchitis
>
>
>Cancer: Indicate Type Here:
>
>
>Carbon Monoxide Poisoning
>
>
>Chemotherapy
>
>
>Chest Pains
>
>
>Chronic Constipation
>
>
>Confusion
>
>
>Dandruff
>
>
>DBS
>
>
>Depression
>
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>Dermatitis
>
>
>Diabetes
>
>
>Difficulty Breathing
>
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>Difficulty Learning New Information
>
>
>Difficulty Rising From a Chair
>
>
>Dizziness
>
>
>Drooling
>
>
>Drug Induced Dementia
>
>
>Drug Induced Hallucinations
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>Drug Induced Nausea
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>Dry Mouth
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>Dyskenesia
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>Dystonia
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>Ear Surgery
>
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>Epstein Barr Virus
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>Facial Mask
>
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>Facial Muscle Weakness
>
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>Fainting
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>Fall Easily
>
>
>Fall Frequently
>
>
>Fatigue
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>
>Feelings of Hopelessness
>
>
>Foul Body Odor
>
>
>Freezing
>
>
>Frequent Urination Not Related to Prostate
>
>
>Get Lost Easily
>
>
>High Blood Pressure
>
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>Hypoglycemia
>
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>Increased Irritability
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>Increased OFF Periods
>
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>Infectious Mononucleosis
>
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>Inner Body Shaking
>
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>Insomnia
>
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>Juxtaposing Keyboard Letters
>
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>Lack of Concentration
>
>
>Leg Cramps Not RLS
>
>
>Light Headedness
>
>
>Long Term Memory Loss
>
>
>Loss of Appetite
>
>
>Loss of Sense of Smell
>
>
>Loss of Sense of Taste
>
>
>Low Blood Pressure
>
>
>Low Blood Sugar
>
>
>Lowered Immune System
>
>
>Medication Induced Sleep
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>Mercury Fillings
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>
>Micrographia
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>
>Misplace Objects
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>
>Mood Swings
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>
>Need for Constant Repetition in Learning New Information
>
>
>Onset of PD Within a Year of Trauma
>
>
>Orthostatic Hypotension
>
>
>Osteoarthritis
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>
>Osteoporosis
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>
>Pallidotomy
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>
>Periods of Unconsciousness
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>
>Persistent Nasal Drip
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>
>Pneumonia
>
>
>Problems Swallowing
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>
>Radiation
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>
>Rapid Heartbeat/Palpitations
>
>
>Rash on Eyelids (Blepharitis)
>
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>Recurring Abdominal Pain
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>Recurring Headaches
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>Recurring Migraines
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>
>Red Splotches
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>
>Respiratory Problems
>
>
>Restlessness
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>
>RLS
>
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>Severe Ear Infections
>
>
>Short Term Memory Loss
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>
>Shuffling Gait
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>
>Slowness of Movement
>
>
>Stooped Posture
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>
>Strep Throat
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>
>Swollen Feet
>
>
>Thyroid Problems
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>
>Urinary Retention
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>
>Urinary Tract Infections
>
>
>Verbalizing Sometimes Lost in Conversation
>
>
>Viral Infections
>
>
>Voice Problems
>
>
>Vomiting
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>
>Weight Gain
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>
>Weight Loss
>
>
>Wheelchair Bound
>
>
>Sleep is interrupted by:                       Tremors                 Full Bladder
>                                                       Dyskenesia                      Dystonia
>                                                       RLS                             Other:_______
>Eating Protein         Does            Interfere With ON Periods.
>                       Does Not
>
>Head Trauma(s):                How many? _________
>                               Severity from 1-10 _______
>
>Vision:        Normal
>               Fuzzy
>               Double
>               Glaucoma
>               Cataracts
>               Other: __________________
>
>
>
>
>
>Surgeries:             How many? _____________
>
>Types: _________________________________
>
>Exposure to:   Pesticides
>                       Chemicals
>                       Glues/Caulks
>                       Solvents
>                       Other: __________
>
> Limbs:                Numbness
>                       Tingling
>                       Dystonia
>                       Dyskenesia
>Other: ____________________________________
>
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