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CENTER FOR SURGICAL DERMATOLOGY & CENTER FOR SURGICAL DERMATOLOGY AMBULATORY SURGERY CENTER Patient Medical History NAME: DATE: DATE OF BIRTH: SEX: M F REFERRED BY: Reason for Today s visit: PAST
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How to fill out if yes, please list:

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Start by reviewing the question on the form or questionnaire that asks if "yes" to a specific condition or criteria exists.
02
If the answer is indeed "yes," proceed to the space provided to list the relevant information or details.
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Take your time to think through and carefully consider all the necessary information that should be included in the list.
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