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Patient Name: CR #: Health Card #: Date of Birth (YYY/mm/dd): Telemedicine Clinical Referral Gender: Telephone: 6135443400 Ext. 3104 Fax: 6135452200 Internet: www.hoteldieu.com Address: Preferred
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Hotel Dieu Hospital is a French term for a hospital that is typically associated with the Catholic Church and provides medical care to the sick and injured.
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