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Patient ID #: XXX Sentinel Questionnaire SITE NAME 1. General InformationForm Version: November 2019Gender: Male Female×Country of Birth:Age:*Clinic Visit Date (Month/Day/Year):Country of Current
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The 2-page geosentinel questionnaire is a document designed to collect data regarding geographic information and related concerns in a specific format, typically involving two pages.
Individuals or organizations who engage in activities requiring geographic reporting as mandated by relevant authorities are required to file the 2-page geosentinel questionnaire.
To fill out the 2-page geosentinel questionnaire, provide accurate and relevant information in the designated fields, ensuring completeness and clarity as per the guidelines provided.
The purpose of the 2-page geosentinel questionnaire is to gather essential geographic data to assist in decision-making and policy formulation within specific domains.
The questionnaire requires reporting on geographic location, demographic details, and other relevant data points specified in the instructions.
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