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Completed by (Name & relationship to patient): Today's Date: At today's visit, I want to discuss: Who cares for your child during the day? Does your child attend preschool? Yes No Tell us about your
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Today's visit i will cover routine check-ups and possibly lab work.
Only individuals who have appointments scheduled for visit i are required to file.
You can fill out the necessary forms and provide any requested information at the visit i appointment.
The purpose of visit i is to ensure your health and address any concerns or issues that may arise.
You must report any symptoms, changes in health, or concerns you may have since your last visit.
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