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Medical InformationPlease check to indicate yes or no after each statement. 1. Are you allergic to any medication? Yes No 2. Are you currently taking any prescribed medications? Yes No 3. Do you have
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Please check to indicate is a phrase used to request that a specific item be marked or selected.
Any individual or entity who needs to provide specific information or indicate a choice may be required to file please check to indicate.
To fill out please check to indicate, simply mark or select the appropriate option or information as requested.
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