📄 Extracted Text (43 words)
WOODSON C. MERRELL, M.D. PLLC
44 EAST 67th STREET
NEW YORK, NEW YORK 10065
Telephone: (212) 535-1012
Fax: (212) 535-1172
Checklist for New Patient Inquiries
Date:
Name:
Age:
DOB:
Address:
Phone:
Email:
Referred by:
Current Primary Physician:
Chief Complaints:
Brief Medical History:
EFTA00296174
ℹ️ Document Details
SHA-256
06246d81a7a0b11db1e01a155a5dae4217446b1f6b471e5bc856300e8449461e
Bates Number
EFTA00296174
Dataset
DataSet-9
Document Type
document
Pages
1
Comments 0