IDENTIFYING INFORMATION

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Current Symptoms Scale

Selected Value: 0
Slide to select severity value between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.
Selected Value: 0
Slide to select the severity between 0-10.

Brief Description of Any of These That Apply:

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