The chiropractor shall include the following in the patient history: Personal data, including: Name, Address, Telephone number, Date of birth, Race, Sex, and Current occupation; Complaint or complaints, including: Description of the complaint or complaints, Quality and character of the complaint or complaints, Intensity, Frequency, Location, Radiation, Onset, Duration, Palliative and provocative factors, and History of present complaint or complaints; Family health history; Past health history, including: General state of health, Previous illnesses, Surgical history, Previous injuries, Hospitalizations, Previous treatment and diagnostic testing, Prescribed and nonprescribed medications and supplements, Allergies, and Mental illness; Systems review, including: Musculoskeletal, Cardiovascular, Respiratory, Gastrointestinal, Neurological, Ophthalmological, Otolaryngological, Endocrine, Peripheral vascular, and Psychiatric; and Personal history, including: Occupational, Activities, Exercise, and Health habits.