Endocrine Sample Clauses

Endocrine. Targets principally involved in diseases of the endocrine system, including, without limitation, [**], but excluding [**] and excluding Targets of [**].

Endocrine. Decreased testosterone (male) and other sex hormones (females); dysfunctional sexual activity.

Endocrine. Heat or cold intolerance Frequent urination Change in appetite Sweating Increase Thirst ❑NONE Psychiatric      

Endocrine. 🞏 Hypothyroid 🞏 Heat or cold intolerance 🞏 Hypoglycemia 🞏 Diabetes 🞏 Excessive thirst 🞏 Excessive hunger 🞏 Fatigue 🞏 Seasonal depression IMMUNE 🞏 Vaccinations 🞏 Reactions to vaccinations 🞏 Chronic Fatigue Syndrome 🞏 Chronic infections 🞏 Chronically swollen glands 🞏 Slow wound healing NEUROLOGIC 🞏 Seizures 🞏 Paralysis 🞏 Muscle weakness 🞏 Numbness or tingling 🞏 Loss of memory 🞏 Easily stressed 🞏 Vertigo or dizziness 🞏 Loss of balance SKIN 🞏 Rashes 🞏 Eczema, Hives 🞏 Acne, Boils 🞏 Itching 🞏 Color Change 🞏 Perpetual Hair Loss 🞏 Lumps 🞏 Night Sweats HEAD 🞏 Headaches 🞏 Head Injury 🞏 Migraines 🞏 Jaw / TMJ problems EYES 🞏 Spots in eyes 🞏 Cataracts 🞏 Impaired vision 🞏 Glasses or contacts 🞏 Blurriness 🞏 Eye pain / strain 🞏 Color blindness 🞏 Tearing or dryness 🞏 Double vision 🞏 Glaucoma Please check all conditions you have now or have had in the past: NOSE AND SINUSES 🞏 Frequent colds 🞏 Nose Bleeds 🞏 Stuffiness 🞏 Hayfever 🞏 Sinus problems 🞏 Loss of smell MOUTH AND THROAT 🞏 Frequent sore throat 🞏 Copious saliva 🞏 Teeth grinding 🞏 Sore tongue / lips 🞏 Gum problems 🞏 Hoarseness 🞏 Dental cavities 🞏 Jaw clicks NECK 🞏 Lumps 🞏 Swollen glands 🞏 Goiter 🞏 Pain or stiffness RESPIRATORY 🞏 Cough 🞏 Sputum 🞏 Spitting up blood 🞏 Wheezing 🞏 Asthma 🞏 Bronchitis 🞏 Pneumonia 🞏 Pleurisy 🞏 Emphysema 🞏 Difficulty breathing 🞏 Pain on breathing 🞏 Shortness of breath 🞏 Shortness of breath at night 🞏 Shortness of breath lying down 🞏 Tuberculosis CARDIOVASCULAR 🞏 Heart disease 🞏 Angina 🞏 High / Low Blood Pressure 🞏 Murmurs 🞏 Blood clots 🞏 Fainting 🞏 Phlebitis 🞏 Palpitations / Fluttering 🞏 Rheumatic Fever 🞏 Chest pain 🞏 Swelling in ankles 🞏 Trouble swallowing Bowel movements – How often? 🞏 Change in thirst Is this a change? 🞏 Nausea 🞏 Vomiting 🞏 Vomiting blood 🞏 Heartburn 🞏 Blood in stool 🞏 Change in appetite 🞏 Pain or cramps 🞏 Constipation 🞏 Belching or passing gas 🞏 Diarrhea 🞏 Black stools 🞏 Gall Bladder disease 🞏 Jaundice (yellow skin) 🞏 Ulcer 🞏 Liver Disease 🞏 Hemorrhoids

Endocrine. Heat or cold intolerance Frequent urination Change in appetite Sweating Increase Thirst NONE Psychiatric       Nervousness Memory Loss Stress Depression Anxiety NONE Workers’ Compensation - “ON THE JOB” Injury ____________ _________   Date Injured _ Last Date Worked _ Has the injury been reported? Yes No If No, Report It Immediately! _______________________________________________________________ Very briefly described how the accident / injury occurred _ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _ _ _ Have you ever injured this area before? Yes No Date(s) & cause of previous injury Name of supervisor, xxxxxxx or manager_ Phone #   ____________________________________ __________________________________ ___________________________________   ______________________________________________________ Have you been contacted by an insurance company or company representative regarding this claim? Yes No Who is your employer’s Workers’ Compensation insurance carrier? _ _______________________________________________________________________ Name & Address Insurance Carrier (if known)_ _   ___________________________________ Do you have an attorney representing you for this claim? Yes No Name of Attorney ____________________________________________________________ _________________________ Address of attorney _ Phone #_ “AUTOMOBILE ACCIDENT – CAR CRASH” ____________ ________________________________________________         R     Date of Accident _Location _Direction Traveling: N S E W Were you: driver front passenger rear passenger pedestrian, (or) I was riding a bicycle motor scooter motorcycle Were you struck from behind t. Side Lt. Side front , Were you stopped –or- moving  

Endocrine. Diseases of the endocrine system, including diseases of the [**] and excluding endocrine system diseases of [**].