Chestionar de sanatate obtineri si preschimbari – Engleza

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  • Chestionar de sanatate obtineri si preschimbari – Engleza

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CHESTIONAR DE SĂNĂTATE OBȚINERI ȘI PRESCHIMBĂRI - ENGLEZA
I request a medical visit for
DECLARATION ON YOUR OWN RESPONSIBILITY
Have you ever been designated UNFIT to drive motor vehicles?
Have you had or do you have one of the diseases below? 
Eye diseases / operations / permanent glasses
Dizziness, fainting, loss of consciousness
Insomnia
Epilepsy, paralysis
Apnea syndrome (stopping breathing during sleep)
Detoxification due to alcohol, medications or drugs
Asthma or other lung diseases
HTN (high blood pressure)
Heart diseases (cardiopathies, sten, pacemaker)
Gastrointestinal diseases
Deafness (deafness) / hearing aid
Blood diseases (leukemia, anemia, thrombophilia)
Diabetes mellitus
Cancer
Kidney diseases
Amputations (fingers, hands, feet)
Other mental illnesses (depression, psychosis, etc.)
For ladies: ARE YOU PREGNANT?
Are you currently taking medication?
Do you drink alcohol?
3. Do you consume ETHNOBOTANICAL substances or DRUGS?
I AM OBLIGATED to inform the medical unit that issued the medical record.

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