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GENERAL
LIFESTYLE
HEALTH
ASSESSMENT
Assessment of Symptoms
1. My abdominal complaints are constant or have got worse in the last few weeks.
Yes
No
Unsure
2. I wake up from sleep because of my symptoms.
Yes
No
Unsure
3. I frequently have fever, joint pains or skin rash.
Yes
No
Unsure
4. I've unintentionally lost more than 3 kg (5 pounds) of weight in the last 3 months.
Yes
No
Unsure
5. I sometimes see blood in the stool or vomit.
Yes
No
Unsure