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Examinee Name
USMLE ID Badge ID
Room Number Encounter


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Diagnosis #1

History Finding(s)
Physical Exam Finding(s)
Positive & Negative Findings
Positive & Negative Findings

Diagnosis #2

History Finding(s)
Physical Exam Finding(s)
Positive & Negative Findings
Positive & Negative Findings

Diagnosis #3

History Finding(s)
Physical Exam Finding(s)
Positive & Negative Findings
Positive & Negative Findings

Physical Exam Maneuver
Diagnostic Study/Studies





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