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Medication Carthage: Carol Parker Date of birth: 26/8/28Room no: 5 Date of admission: 03/03/03Medicare no: 258884561 Pension no: 692016Doctor B. GrimshawPharmacist Swallowing Resident Self Administers
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To fill out name, first write your first name and then your last name. For example, if your name is Carol Parker, write 'Carol' in the first box and 'Parker' in the second box.
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To fill out date of birth, write your date of birth in the format MMDDYY. For example, if you were born on February 6, 1988, you would write '020688'.

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The name is Carol Parker and the date of birth is 26/8/1988
Anyone with the necessary information about Carol Parker born on 26/8/1988 is required to file.
You can fill out the form with the correct name and date of birth of Carol Parker, either electronically or in paper form.
The purpose is to correctly identify and report information about Carol Parker for record-keeping or compliance purposes.
The information required would typically include personal details, such as name, date of birth, and any relevant details for the specific form or document.
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