| Document Date: 2014-05-15 15:53:14
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City PHONE ADDRESS CITY / / MedicalCondition HIV infection / Mental health disorders / Congenital heart defects / radiation-induced immunosurpression Diabetes / Allergies / Night sweats Cardiovascular disease / week duration Cough / disease / Angina ____Heart murmur Osteoporosis / Arteriosclerosis / Neurological disorders / seizures Gastrointestinal disease G.E. Reflux/persistent heartburn Glaucoma / Emphysema / Bronchitis / Rheumatoid arthritis / neck pains / earaches / Congestive heart failure ____Pacemaker Severe headaches/migraines / Dry Mouth Eating disorder / Epilepsy Fainting / Recurrent Infections Arthritis / Heart attack Sinus trouble Chest pain / diseases / AIDS / Coronary artery disease / exertion Chronic pain Disease / infection / Hepatitis / liver disease Anemia / illness / Malnutrition Cancer/Chemotherapy / lupus / serious illness / ____Mitral valve prolapse / narcotics Latex Iodine Hay fever / Kidney problems Asthma / / MedicalTreatment Radiation Treatment / Premedication / antibiotics / Blood transfusion / Chemotherapy / radiation / / Organization American Dental Association / / Position dentist / physician / receptionist / / Product Penicillin / / Technology Radiation / Chemotherapy / /
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Medical Alert: Condition: Premedication: