📄 Extracted Text (36 words)
, M.D.
44 EAST 67th STREET
NEW YORK, NEW YORK 10065
'FrIt-phola
HA:
Checklist for New Patient Inquiries
Date:
Taken By:
Name:
Age:
DOB:
Address:
Phone:
SS#:
Email:
Referred by:
Current Primary Physician:
Chief Complaints:
EFTA00521137
ℹ️ Document Details
SHA-256
40faa872bc117b0922ea495dcd276bae3f45cd584f37ead81a1d8d29a8d50409
Bates Number
EFTA00521137
Dataset
DataSet-9
Document Type
document
Pages
1
Comments 0