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Name Phone () DOB Address City State Zip Email: Referred by: Occupation In case of emergency: Phone () Primary Health Care Provider Please read and answer the following questions carefully regarding
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The SF Department of Public refers to the San Francisco Department of Public Health, which is responsible for protecting and improving the health of all San Franciscans.
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Individuals and businesses that are regulated by the San Francisco Department of Public Health, including those involved in food service, clinical trials, and certain health-related activities, are required to file.
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