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Page 1: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 2: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 3: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 4: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 5: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 6: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 7: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 8: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 9: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 10: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 11: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 12: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 13: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N
Page 14: dyfc.orgdyfc.org/wp-content/uploads/2011/08/CURRENT-New-Patient...o D A w Low-grade fevers Night sweats Chills Pa Name 2 Subtotal Page 2 of 3 Symptoms Checklist OFFICE USE ONLY o N

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