EFTA02314900.pdf
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📄 Extracted Text (36 words)
WOODSON C. MERRELL, M.D.
44 EAST 67th STREET
NEW YORK, NEW YORK 10065
Fax:
Telephone
Checklist for New Patient Inquiries
Date:
Name:
Age:
DOB:
Address:
Phone:
SS#:
Referred by:
Current Primary Physician:
Chief Complaints:
EFTA_R1_01208164
EFTA02314900
ℹ️ Document Details
SHA-256
ff4317f3cc1e577dffe36e8337614fa8c87ea44aae162b98532b3806f3384631
Bates Number
EFTA02314900
Dataset
DataSet-11
Type
document
Pages
1
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