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St. Martin s-in-the-Fields 5220 Clemson Avenue Columbia SC 29206 Phone 803-787-0392 fax 803-782-5658 Email michelle. I consent to X-rays examination anesthetic medical or surgical diagnosis treatment and hospital care. If you need more space please use the back of this page or attach another page. Last Tetanus Shot Allergies to Medicine or other Current Medications Please list and explain any chronic medical conditions or major illnesses the child experienced in the last year Should this...
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