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NORTHERN ARIZONA ALLERGY, ASTHMA, & IMMUNOLOGY 930 N. Switzer Canyon Drive, Suite 101 Flagstaff, Arizona 86001 Phone: (928)7741700 Fax: (928)2268634 PATIENT HISTORY FORM PATIENT NAME: GENDER: FEMALE
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Norformrn Arizona Allergy Asthma is a form used for reporting allergy and asthma information in Arizona.
All healthcare providers or facilities treating patients with allergies or asthma in Arizona are required to file Norformrn Arizona Allergy Asthma.
To fill out Norformrn Arizona Allergy Asthma, healthcare providers need to include detailed information about the patient's allergies and asthma history.
The purpose of Norformrn Arizona Allergy Asthma is to track and monitor allergy and asthma cases in Arizona for public health purposes.
Information such as patient demographics, allergic triggers, asthma medications, and treatment history must be reported on Norformrn Arizona Allergy Asthma.
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