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PatientQuestionnaire Name: Date: PAST MEDICAL HISTORY (If YOU have EVER had any of these conditions, please indicate with an X) Breast Conditions AbnormalMammogram BreastCancerLeftRight BreastImplants
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If you have ever refers to a form or document that individuals need to fill out if they have certain experiences or situations in their past.
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Individuals must report detailed information about their past experiences or situations, including dates, locations, and specific details.
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