EFTA00301537.pdf

DataSet-9 1 page 33 words document

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📄 Extracted Text (33 words)

Name:
D.O.B:

                           Health Update 2016
Current Medications:

Medical History:

Allergies to Medication:

Surgical History:                     Hospitalizations:

Social History: (Yes/No, How Often)   Family History:
Tobacco:                              (Status, Age, Health History)

Marijuana:                            Mother:

Alcohol:
                                      Father:
Caffeine:

                                                                      EFTA00301537

ℹ️ Document Details

SHA-256

4a4c3cc48bd40b84a9b2a8ac825c68c13721be95a878c52acd99fa6ae53f29af

Bates Number

EFTA00301537

Dataset

DataSet-9

Document Type

document

Pages

1

Comments 0

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