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PATIENT INTAKE FORM TODAYS DATE PATIENT INFORMATION Title: Mr. Mrs. Ms. Dr. Sex: MASS #: Age: Date of Birth: / / First Name: Middle Initial: Last Name: Address Apt # City State Zip Code Home Phone:
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To fill out today's date in the north format, follow these steps:
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Begin by writing the numerical day of the month, followed by a comma.
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Write the abbreviated month name in capital letters, followed by a space.
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Then, write the full four-digit year, followed by a comma and a space.
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Finally, add the time zone indicator 'North' to indicate the north format of the date.
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Example: '25, SEP 2021, North'

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Today's date is January 15, 2023.
All residents of the North region are required to file today's date.
To fill out today's date, simply write the current date as mentioned.
The purpose of today's date is to keep track of time and events in the North region.
On today's date, residents must report any significant events or updates in their lives.
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