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Name: Birthdate: Date: PATIENTPREFERENCES: PrimaryCarePhysician: LocalPharmacyandPhoneNumber: MailOrderPharmacy: ImagingCenter:GwinnettMedicalCenterEastsideEmoryJohnsCreek
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To fill out the namebirthdatedate, follow these steps:
1. Start by writing your full name in the designated field.
2. Enter your birthdate in the specified format, usually in month/day/year.
3. Provide your birthdate accurately to ensure correctness.
4. Double-check your input to avoid any errors or discrepancies.
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