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MEDICAL/BEHAVIORAL HEALTH HISTORY 1 OF 2 Updated 2/4/2022 Maple Street Clinic 109 E. Maple, Gillespie, IL 62033 2178391526 Medical/Behavioral 2178391538 FAX 2178394110 Dental Morgan Street Clinic
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The McPhDNetMaple Street Clinic in Macoupin County is a healthcare facility that provides medical services to the community.
Individuals or entities who have received services from the clinic and are required to report specific information.
The form can be filled out online on the clinic's website or submitted in person at the clinic.
The purpose of the form is to collect data for record-keeping and statistical analysis by the clinic.
Personal information, medical history, and demographic data may be required for reporting.
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