Normal Abnormal Data to be filled in by site Allergic/Immunologic Not examined Normal Abnormal Data to be filled in by site Cardiovascular Not examined Normal Constitutional symptoms (e.g., Abnormal Data to be filled in by site fever, weight loss) Not examined Normal Abnormal Data to be filled in by site Ears, Nose, Mouth, and Throat Not examined Normal Abnormal Data to be filled in by site Endocrine Not examined Normal Abnormal Data to be filled in by site Eyes Not examined Normal Abnormal Data to be filled in by site Gastrointestinal Not examined Normal- Abnormal Data to be filled in by site Genitourinary Not examined Normal Abnormal Data to be filled in by site Hematologic/Lymphatic Not examined
Allergic/Immunologic Normal Abnormal Not examined Data to be filled in by site Cardiovascular Normal Abnormal Not examined Data to be filled in by site Constitutional symptoms (e.g., fever, weight loss) Normal Abnormal Not examined Data to be filled in by site Ears, Nose, Mouth, and Throat Normal Abnormal Not examined Data to be filled in by site Endocrine Normal Abnormal Not examined Data to be filled in by site Eyes Normal Abnormal Not examined Data to be filled in by site Gastrointestinal Normal Abnormal Not examined Data to be filled in by site Genitourinary Normal- Abnormal Not examined Data to be filled in by site Hematologic/Lymphatic Normal Abnormal Not examined Data to be filled in by site