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Date ADULT PATIENT INFORMATION Patients name Last First Middle Residence Street City Zip Mailing Address Street City How long at this address? Zip Home phone Work phone Previous Address (If less than
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What is adult hh dr khandocx?
Adult hh dr khandocx stands for Adult Household Doctor Khandocx, which is a form used to report medical information about adult household members.
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Information such as medical history, current medications, allergies, and any existing health conditions must be reported on the adult hh dr khandocx form.
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