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!APPLICATIONFORCAREAT212DEGREESOFWELLNESSTodaysDate: / / PATIENTDEMOGRAPHICS! Name: BirthDate: Age: Sex: MaleFemale Address: City: State: Zip:
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What is namebirthdate--agesexmalefemale?
namebirthdate--agesexmalefemale is a form used to collect personal information such as name, birthdate, age, and gender (male/female).
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What information must be reported on namebirthdate--agesexmalefemale?
namebirthdate--agesexmalefemale requires you to report your full name, birthdate, age, and specify your gender as male or female.
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