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PAST MEDICAL HISTORY Formation Name: Date: Are you presently working? Yes Notate of next physicians visit: / / Date of injury / onset: / / Have you ever had physical therapy for these symptoms before?
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Yes nodate of next refers to a specific date in the future that has not yet arrived.
Anyone who needs to make plans or preparations for events occurring after that date may need to consider the yes nodate of next.
Yes nodate of next does not need to be filled out. It is simply a reference point for future events.
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