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FAMILY HEALTH CARE MEDICAL GROUP OF MODESTO HEALTH HISTORYDate of Birth Patient Age Sex Birthplace Family Structure: Head of household Date of birth Spouse Date of birth Children Sex Date of birth
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It is a form used for reporting information related to healthcare.
Healthcare providers and facilities are required to file the form.
The form can be filled out online or manually and must include accurate information.
The purpose is to track and report healthcare data for regulatory and informational purposes.
Information such as patient demographics, procedures performed, and billing details must be reported.
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