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George O. D. Date of Birth Home Phone Work Phone Cell Phone PATIENT MEDICAL HISTORY List any medications you take List all major illnesses or injuries diabetes high blood pressure emphysema heart attacks whiplash cancer Do you have any allergies to medications If Yes please list the medications List any surgeries you have had List all eye illnesses or injuries crossed/lazy eye cataract glaucoma macular degeneration retinal detachments abrasions etc. Do you currently have any problems in the...
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