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WWW.columbiaradiology.com BREAST IMAGING HISTORY FORM NAME DATE OF BIRTH AGE PHYSICIAN(S) TO RECEIVE EMAIL: REPORTS DAY PHONE EVENING PHONE YOUR ADDRESS Could you be pregnant? Yes No Inform the technologist

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What is date of birth age?

Date of birth age refers to the age of an individual calculated based on their date of birth.

Who is required to file date of birth age?

Any individual or entity required by law to report age related information.

How to fill out date of birth age?

Date of birth age can be filled out by providing the date of birth of the individual and calculating their current age based on that information.

What is the purpose of date of birth age?

The purpose of providing date of birth age is to verify the age of an individual for various legal, regulatory or administrative purposes.

What information must be reported on date of birth age?

The information required to be reported on date of birth age includes the individual's date of birth and their calculated age.

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