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DOB: Age: Name: What issues concerning your health would you like to discuss today? Date: Drug Allergies: Food / Material Allergies (include Latex): Medical History: Have you ever had or been diagnosed
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Start by carefully reading the instructions or guidelines provided for filling out the form on what issues concern you.
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Make a list of the specific issues you want to address or discuss. This could include personal concerns, professional matters, or community-related issues.
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It refers to any problems or concerns related to you.
Any individual or entity who has knowledge of the issues concerning you may be required to file.
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The purpose is to address and resolve any issues or concerns that may impact you.
You must report specific details and facts related to the issues concerning you.
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