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Unremarkable Sibling3 M F Father Family History Comments Mother Unknown Age at death if Deceased Aneurysms CVA Stroke Cancer Heart Disease Hypertension Other Family History SOCIAL AND OCCUPATIONAL HISTORY Marital Status Children Single Student Status Married Full Student Highest level of Education Post Grad. Divorced Part Student High School Non-Student College Grad. Caffeine Use Coffee Tea Energy Drinks Soda Never Exercise frequency Daily 3-4xs/week 2-3xs/week Rarely Employed Yes Occupation...
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Start by writing your first name, followed by a space.
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Next, write your middle initial, again followed by a space.
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Finally, write your last name.

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