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Date: HISTORY FORM FOR PATIENT WITH TEMPOROMANDIBULAR DISORDERPatients Name: Date of Birth: Age: Sex: Male Females. S.N./S.I.N.: Address: City: State/Province/Postal Code: Referred by: MAJOR REASON
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The date of birthagesex malefemale refers to the individual's date of birth and gender.
It is required to be filed by individuals for identification purposes.
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The purpose of date of birthagesex malefemale is to establish identity and demographic information.
The information to be reported includes date of birth and gender of the individual.
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