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Date PatientName(Greasepaint) DateofBirth Usingthesymbolsbelow, pleasedrawinthelocationofyoursymptomsonthediagrams. PATIENT HowardWSharfMD GlennSFuocoDO Page1 Pain X XXX Numbness 0 000 Aching / /////

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Tbos sharf fuoco new is a form used for reporting financial information to the relevant authorities.

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