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Special Claim Accident Work Auto Your Insurance Carrier Claim Adjuster s Name Telephone Extension Date of Accident Camas Family Health Center 235 NE 6th Avenue Camas Washington 98607 Phone 360 834-5126 Fax 360 838-1582 Dustin Brubaker LMP Kitrina DePaolo LMP Kris Good LMP Elizabeth Loop. LMP Samantha VanDinter LMP Patient Questions What is your major symptom/problem Have you ever had a professional massage before Yes No Do you have difficulty laying on your front back or side Yes No If yes...
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To fill out the field 'dateofbirthsexmalefemale', follow the steps below:
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Locate the field labeled 'dateofbirthsexmalefemale' in the form.
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Enter your date of birth in the specified format. For example, if your date of birth is January 1, 1990, enter '01/01/1990'.
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Select your sex by choosing either 'male' or 'female' from the provided options.
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What is dateofbirthsexmalefemale?
Dateofbirthsexmalefemale is a placeholder for a specific date of birth or sex (male/female) information.
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To fill out dateofbirthsexmalefemale, simply input the accurate date of birth or specify the sex as male or female.
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The purpose of dateofbirthsexmalefemale is to accurately record and report date of birth or sex information as needed.
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The information reported on dateofbirthsexmalefemale must include the date of birth and/or specify the sex as male or female.
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