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DESERT WEST OBSTETRICS AND GYNECOLOGY PATIENT INFORMATION PLEASE PRINT LAST NAME: FIRST NAME: MI: NICKNAME: MAIDEN: PREFIX: BIRTHDAY: / / MARITAL STATUS: Singles#: Married Divorced Widowed Other:

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Desert West Obstetrics and is a medical practice specializing in obstetrics and gynecology.

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Patients who receive medical services from Desert West Obstetrics and are required to file it.

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Patients need to report their medical history, current medications, and any allergies on Desert West Obstetrics and form.

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