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Please list with dosage. Has puberty and/or menstruation begun Y N N/A Has your child had any serious illnesses or operations If yes describe If yes give approximate dates Is your child pregnant Y N Nursing Y N Taking birth control pills Y N Check if your child has or has ever had any of the following Cortisone Treatments Hepatitis Anemia Arthritis Rheumatism Cough Persistent High Blood Pressure Artificial Heart Valves Coughing Blood HIV/AIDS Artificial Joints Diabetes Jaw...
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