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POOLE AND THOMAS PEDIATRICS, PLC PRENATAL VISIT DATE ___ REFERRED BY ___ PARENTS NAME ___ PARENTS NAME ___ ADDRESS ___ CITY ___ STATE ___ZIP CODE___ PRIMARY PHONE (___)___ HOME/CELL SECONDARY PHONE
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Form years 1768 refers to a specific tax or reporting form required for a certain year, typically used by individuals or entities to report income, deductions, or other financial information.
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Required information typically includes personal identification details, income sources, deductions, credits, and any other relevant financial information.
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