30. ( ) ( ) History of this pain before Yes No 31. ( ) ( ) Past medical history Yes No 32. ( ) ( ) Past surgical/ob history Yes No 33. ( ) ( ) Prescription Medications Yes No 34. ( ) ( ) OTC medications Yes No 35. ( ) ( )
30. History of this pain before ( ) Yes ( ) No 31. Past medical history ( ) Yes ( ) No 32. Past surgical/ob history ( ) Yes ( ) No 33. Prescription Medications ( ) Yes ( ) No 34. OTC medications ( ) Yes ( ) No 35. ( ) ( )
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