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Patient History and Environmental Assessment Please fill out this form to the best of your knowledge. If some questions are not applicable to you or your child, write N/A. If you need more space or
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The file contains information about pediatric services provided by Wasatch Pediatrics.
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Healthcare providers and organizations offering pediatric services are required to file the document.
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The document must be filled out with accurate information regarding pediatric services provided by the organization.
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Information such as patient demographics, types of services offered, and quality of care provided must be reported.
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