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3 to 5 Day Date___ Form revised 07/2022Name___ Birth Date___ Age___ Historian___ Allergies___ Medications___ Weight___kgs. Length___cm W/L ___ %tileHead circ. ___cmTemp.___ AX REC B/P if indicated

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3 to 5 day refers to a specific time period, typically used to describe a forecast or a waiting period.

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