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PATIENT INTAKE FERTILE: OFFICE USE ONLY:SURNAME: Intake Date:Practitioner: Dr. S. Vendible Dr. K. Prater Dr. J. MokrzyckiFIRST NAME: BIRTHDATE: AGE: SEX: M / Informed consent: Y / N / Limited Flags:
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The coat of arms is a heraldic visual design on shields or escutcheons that symbolizes a person, family, country, corporation, or state.
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Individuals, families, countries, corporations, and states who wish to have a symbol that represents them are required to file for a coat of arms.
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To fill out a coat of arms, one must provide the necessary information about themselves, their family, or their organization to a heraldic authority.
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The purpose of a coat of arms is to visually represent and symbolize the identity, values, and history of the individual, family, country, corporation, or state it belongs to.
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The information reported on a coat of arms includes symbols, colors, charges, and mottoes that hold significance to the individual, family, country, corporation, or state.
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