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Optimal Health Nutrition Counseling 1165 Imperial Drive, Suite 200 Hagerstown, MD 21740 www.cwchagerstown.comPatient Information Questionnaire Name: DOB: Today's date: Reason for visit: Primary Care
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Capital Women's Care is a network of OB/GYN physicians that provide women's health services.
Patients who seek medical care from Capital Women's Care are required to have their information filed by the healthcare providers.
The patient or their healthcare provider can fill out the Capital Women's Care form with the required medical information.
The purpose of Capital Women's Care is to document and track the medical history and health status of female patients.
Information such as medical history, current health conditions, medications, and treatments must be reported on Capital Women's Care.
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