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PERSONAL MEDICAL HISTORY Name: DOB: / / Address: Phone: / Email: 1. Med. Ins. Provider: Policy#: Group: Phone: / Address: 2. Med Ins. Provider: Policy#: Group: Phone: / Address: Emergency contact:
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Open the contact or profile section where you want to fill out the phone and email information.
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Look for the designated fields for phone and email.
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Click or tap on the phone field and enter the phone number using the keypad or keyboard. Make sure to include the country code if applicable.
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Similarly, click or tap on the email field and enter the email address using the keyboard.
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Repeat these steps for any additional phone or email fields if needed.

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Phone-email is a form of communication using both telephone and email technology.
Individuals or organizations who need to communicate effectively and efficiently.
Fill out the form by providing relevant contact information for both telephone and email.
The purpose is to enable easy and quick communication between parties.
Contact details such as phone number and email address must be reported.
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