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GYNECOLOGIC INTAKE HISTORY NAME:___BIRTH DATE:___/___/___DATE:___/___/___REVIEW OF SYSTEMSPLEASE CHECK (X) IF ANY OF THE FOLLOWING APPLY TO YOU NOW, IN THE PAST OR OFTEN1. CONSTITUTIONALCURRENTLYPASTWeight

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2 eyes is a term used in certain reporting or regulatory contexts, often referring to a specific form or procedure that requires dual verification.

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