Microsoft word - patient medical history rheumatology
Date of Appointment: WMG Account Number: PERSONAL AND SOCIAL HISTORY Do you live alone? Education: Do you regularly consume alcohol? Average number of drinks per week (now or in the past)? How would you describe your cigarette smoking? How many packs per day do you (or did you) smoke? Does anybody smoke in the house in which you live? How many caffeinated beverages do you consume pe