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Registration Form Please print clearly Today's Date: / / PATIENT INFORMATION First Name: MI: Last Name: Address: City: State: Zip: Date of Birth: / / Gender: M FE Mail: Phone: Daytime (HM/WK/CELL)
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What is today's date?
Today's date is September 14, 2021.
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Today's date is used for record-keeping, scheduling, and accountability purposes.
What information must be reported on today's date?
Any relevant events, appointments, or activities that occurred on the current date.
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