Get the free doh.wa.gov sites defaultReporting Form For Poliomyelitis/AFM - doh.wa.gov - doh wa

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Case name (last, first) ___ Birth date ___/___/___Age at symptom onset ___YearsMonthsAlternate name ___Poliomyelitis/Phone ___CountyStreet address ___Address typeHomeMailingEmail ___OtherTemporaryWorkCity/State/Zip/County

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