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CONFIDENTIAL REFERRING CLINICIAN/ LABORATORYPATIENTS DETAILS Name:Name/ StampSurname: Fathers Name:MEDICAL HISTORYHusbands Surname:Date of Birth:Place:Address:P.C.:Tel.:email:Date of blood withdraw:

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What is this is your moment?

This is your moment refers to a specific point in time or situation where an individual feels empowered or inspired.

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This is your moment does not require any specific individual to file it. It is a personal experience or feeling.

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This is your moment cannot be filled out as it is a subjective feeling or experience.

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The purpose of this is your moment is to capture a moment of personal significance or empowerment.

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No specific information needs to be reported on this is your moment as it is a personal experience.

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