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Medical Genetics Program of Southwestern Ontario Tel 519-252-7281 Ext 350 Fax 519-977-2216 Your child may be offered genetic testing following their assessment by the geneticist. It would be helpful to have the following information available. Name of patient Name of person completing this form Phone Biological Mother Last Name First Name Date of Birth Health Card Number Version Code Mailing address if different than child s Last Name First Name Is the child under the care of the Children...
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