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Coastal Kids To be completed by patient 18 years of age and older. Personal Information Last Name: ___ First Name: ___ Middle Initial: ___ Date of Birth (DOB): ___SS# _________Sex: M / Employer: ___Language:
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What is please circle m f?
Please circle m f refers to selecting the appropriate gender option by circling either 'm' for male or 'f' for female.
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Individuals who are asked to provide their gender information on a form or document are required to fill out please circle m f.
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