ainting or seizures, 0 NO oyes Surgical History - Please Inc dotes. if any 0 HOMY Parefes -.Plea list Reactions: O hone 0 Later 0 Other. Social History-. Highest Lent of Education.. OCOleitIOR: Mantal er S/ngle °Married 0 Divorced °Widowed °Partnered Tobacco Use MONS Ust illicit Drug Use