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Past Medical HistoryInstructions: Please check all that apply
YesNoYesNoFamily History:
Deceased? Allergies (excluding medications)GoutFatherAsthmaHeart murmur (as an adult)MotherAnemia (Type: ___)Heart
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Michigan Primary Care PhysiciansMichigan is a program designed to track and maintain primary care physician information in the state of Michigan.
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Primary care physicians are required to report their contact information, medical specialty, practice information, and license details on michigan primary care physiciansmichigan form.
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