Medical History


Please answer the following

Do you have or have you had any of the following?

{
  "name": "",
  "birthDate": "",
  "info": "",
  "questions": [
    {
      "id": 1,
      "text": "Are you under a physician's care now?",
      "value": false,
      "input": true,
      "moreInfo": ""
    },
    {
      "id": 2,
      "text": "Have you ever been hospitalized or had a major operation?",
      "value": false,
      "input": true,
      "moreInfo": ""
    },
    {
      "id": 3,
      "text": "Have you ever had a serious head or neck injury?",
      "value": false,
      "input": true,
      "moreInfo": ""
    },
    {
      "id": 4,
      "text": "Are you taking any medications, pills or drugs?",
      "value": false,
      "input": true,
      "moreInfo": ""
    },
    {
      "id": 5,
      "text": "Are you on a special diet?",
      "value": false,
      "input": true,
      "moreInfo": ""
    },
    {
      "id": 6,
      "text": "Do you use tobaco?",
      "value": false,
      "input": false
    }
  ],
  "conditions": []
}

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