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COMMUNITY PHARMACY SMOKING CESSATION SERVICE FOR OFFICE USE ONLY Pharmacy ID number: TO BE COMPLETED BY THE CLIENT Name: Male Date of birth: / /19 If you are female, are you pregnant? YES NO UNKNOWN
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The "to be completed by" section needs to be filled out by the person or entity responsible for fulfilling the task or activity outlined in the form or document. This could be an employee, manager, contractor, or any other relevant party involved in the process.
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