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REPEAT DEXA SCAN NAME: ___ DATE: ___ ADDRESS: ___ CITY, STATE, ZIP ___ PHONE: ___ DOB: ___AGE: ___ M or F PHYSICIAN: ___ PERSONAL HISTORY Do you smoke? Y NIf yes, how many cigarettes per day? ___
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The new hx frm page is a revised form that businesses or individuals must use to report specific information related to their operations, compliance, or taxes.
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