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Name: Date: Using the appropriate symbols, mark the areas of pain. Include all affected areas. Numbness Pins & Needles Burning Aching Stabbing ---------------------- 0000000 0000000 0000000 XXXIX
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Start by opening the form that requires your name and date. This can be an online form or a physical paper form.
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In the "Date" field, enter the current date. This is the date when you are filling out the form. Most forms will require you to use a specific format for the date, such as MM/DD/YYYY or DD/MM/YYYY. Double-check the form's instructions to ensure you enter the date correctly.
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