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ERIC R NELSON MD PC PATIENT MEDICAL HISTORY INFORMATION9287761004 Office 9287761276 Patient NAME First Nameless Name DATE LIST ALLERGIES TO ANY MEDICATIONS, DYES, OR ADHESIVESLIST ALL MEDICATIONS

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Page 1 of 4 typically refers to the first page of a multi-page form or document, often related to tax filings or legal papers.

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Information that must be reported on page 1 of 4 includes identifying details of the filer, relevant financial data, and specific declarations as required by the form.

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