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LIGHTHOUSE PEDIATRICS Patient Information FormProvider: (Circle one) Dr. Dudley Dr. Shepard Dr. VedderRace (circle): White Black Asian Other___ DeclinedEthnicity (circle):Hispanic Not Hispanic DeclinedPreferred
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Lighthouse Pediatrics Dr. Luz is a pediatric clinic run by Dr. Luz.
Parents or legal guardians of pediatric patients are required to file Lighthouse Pediatrics Dr. Luz forms.
To fill out Lighthouse Pediatrics Dr. Luz forms, parents or legal guardians need to provide accurate information about the pediatric patient's medical history and current health status.
The purpose of Lighthouse Pediatrics Dr. Luz forms is to gather important medical information about pediatric patients to ensure proper care and treatment.
Information such as medical history, current health status, allergies, medications, and any other relevant medical information must be reported on Lighthouse Pediatrics Dr. Luz forms.
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