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METROPOLITAN NEUROSURGERY ASSOCIATES PA Name Date of Birth Age Current problem briefly state why you are here to see the doctor Medical History Current Height Weight Right or Left Handed Please review the following list and circle Yes or No if you have condition Condition / Disease Diabetes---------------Pneumonia------------Kidney Disease------Heart Disease--------Heart Murmur--------Asthma ----------------Anemia-----------------Hepatitis---------------Cancer-----------------Arthritis...
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