Name	Value
REPORT NUMBER	40
INSTRUMENT	HIH
RPT	.\|.\|Health Issue History\|\|Date Given: <.Date_Given.>\|Clinician: <.Staff_Ordered_By.>\|Location: <.Location.>\|\|Veteran: <.Patient_Name_Last_First.>\|SSN: <.Patient_SSN.>\|DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\|Gender: <.Patient_Gender.>\|\|\|1. Airways and Breathing System\| <Answer_4065>\|2. Allergies and Immune System\| <Answer_4066>\|3. Alchol History\| <Answer_4067>\| $~

Name

Value

REPORT NUMBER

INSTRUMENT

RPT

.|.|Health Issue History||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB: <.Patient_Date_Of_Birth.> 
(<.Patient_Age.>)|Gender: <.Patient_Gender.>|||1. Airways and Breathing System|    <*Answer_4065*>|2. Allergies and Immune System|    <*Answer_4066*>|3. Alchol History|    <*Answer_4067*>|    $~

40 (40) MH REPORT (601.93)