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Name: Date of Birth: Please complete this checklist (Health Risk Assessment) before seeing your doctor or nurse. Your answers will help you receive the best health care possible. 1. During the past
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Please complete this checklist is a form that requires specific information to be filled out.
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Details such as name, address, contact information, and any specific requirements mandated by the authority.
When is the deadline to file please complete this checklist in 2024?
The deadline for filing the checklist in 2024 is December 31st.
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