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Ronald H. Staff, MD Christine Stable, PA-C To our Patients: Please fill out this side while you wait: (Circle appropriate answer and please print legibly.) Name DOB Today's Date Primary care doctor
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How to fill out since your last visit:
01
Start by gathering all relevant information about the period since your last visit. This includes any changes in your health, medications, lifestyle, and any symptoms or concerns you may have experienced.
02
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03
Provide accurate and detailed information when completing any forms or questionnaires related to your visit. This will help your healthcare provider have a comprehensive understanding of your health status and any changes that may have occurred.
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