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Create the ch 205 PDF and enter the material for each and every segment:
Fill in the Blood Pressure age yrs, Date Screened, M Yes M No Screening Results M WNL, M AdaptiveSelfHelp M Gross, Nutrition year M Breastfed M, SCREENING TESTS, Date Done, Results, Blood Lead Level BLL required at, gdL, Hearing, Date Done, Results, years gross hearing, and MNl MAbnl MReferred field using the data requested by the application.
You can be asked to write down the data to let the application fill out the segment Health Care Practitioner Signature, M Other, Date Form Completed, DOHMH ONLY, PRACTITIONER ID, Health Care Practitioner Name and, Practitioner License No and State, Facility Name, Address, Telephone, National Provider Identifier NPI, City, State, Zip, and Fax.
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