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Date: CONFIDENTIAL American Association of Orthodontists MEDICAL DENTAL HISTORY FORM ADULT Patient's Last Name: First: Birthdate: Age: Middle: Sex: Male Female Home Phone No.: (S.S.N./S.I.N.:) Patient's

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The Date Confidential American Association is an organization dedicated to protecting the privacy of individuals and companies by maintaining the confidentiality of sensitive information.

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Information such as the types of data collected, security measures in place, and any data breaches must be reported on the Date Confidential American Association form.