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OTHER
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Directory Results for New Patient History Name DOB completed by M/F Relationship to patient to New Patient History Name: Date of Birth: Age: Date: *The following three questions are for demographic purposes only, as required by the Federal Governments new Electronic Health Record Meaningful Use Program Race*: ( ) Asian ( ) Native

New Patient History Name DOB completed by M/F Relationship to patient
New Patient History Name: Date of Birth: Age: Date: *The following three questions are for demographic purposes only, as required by the Federal Governments new Electronic Health Record Meaningful Use Program Race*: ( ) Asian ( ) Native