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Kids Doc of Southern California Medical Group, Inc. Please Print Clearly Patient (Child's) Information: Last Name: First Name: Initial: Date of Birth: / / Age: Sex: Male Female Primary Care Physician:
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What is patient childs information?
Patient child's information includes details such as name, date of birth, medical history, and any allergies.
Who is required to file patient childs information?
Parents or legal guardians of the patient child are required to file the information.
How to fill out patient childs information?
Patient child's information can be filled out by providing accurate details on a form provided by the healthcare provider.
What is the purpose of patient childs information?
The purpose of patient child's information is to ensure proper medical treatment and care for the child.
What information must be reported on patient childs information?
Information such as name, date of birth, medical conditions, allergies, and emergency contacts must be reported.
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