Anterior Hip

5. VascularDo you have light headedness or dizziness?Have you ever fainted or blacked out?Are your ankles or feet swollen?Have you ever had a blood clot?Do you have circulation problems in your hands or feet?Do you have varicose veins?Do you ever get leg cramps?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No6. MusculoskeletalDo you have an implant or prosthetic device? (if yes, list_____)Do you have arthritis in other joints?Have you ever had a fracture? (If yes, where:________)Are any of your extremities deformed?Do you have any muscle diseases?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No7. DigestiveDo you have heart burn?Do you feel bloated with meals?Do you have excessive belching?Do you frequently become nauseated?Have you ever vomited blood?Do you have difficulties or pain with swallowing?Are your bowel movements loose for more than a day?Are your bowel movements black and tarry or bloody?Have you ever had bleeding from your rectum?Have you had any appetite changes?Have you ever been diagnosis with an ulcer?Have you ever been diagnosed with a hiatus hernia?Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No8. EndocrineAre you a diabetic?Do you use insulin?Do you use oral agents?Have you ever been diagnosed with a thyroid problem?Have you ever been diagnosed with a pituitary problem?Have you had recent weight loss (amt: ______)Have you had recent weight gain (amt:______)Other:apple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple Noapple Yes apple No