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8

Pulse O²: 9

Pulse O²: 10

Pulse O²: 11

Pulse O²: 12

Pulse O²: 13

Pulse O²: 14

Pulse O²:

Date: Diamox:

Location: Head:

Date: Diamox:

Head:

Head:

Head:

Head:

Body:

General:

Eating:

Sleep:

Bathroom:

Body:

General:

Eating:

Sleep:

Bathroom:

Body:

General:

Eating:

Sleep:

Bathroom:

Body:

General:

Eating:

Sleep:

Bathroom:

General:

Eating:

Sleep:

Bathroom:

General:

Eating:

Sleep:

Bathroom:

Location: Head:

Date: Diamox:

Bathroom:

Location:

Date: Diamox:

Sleep:

Location:

Date: Diamox:

Eating:

Location:

Date: Diamox:

General:

Location:

Date: Diamox:

Body:

Body: Location:

Head:

Body:

Comments:

Key:

ü = Yes ø = No

G = N = F = P =

Good Normal Fair Poor

1 2 3 4

= = = =

No Pain Mild Pain Moderate Pain Severe Pain

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