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In the section DATE, OF, EXAM SEX, HEIGHT, WEIGHT, BLOOD, PRESSURE e, Results, mm fAction, Taken, if, positive g, Chest, X, ray, Results h, Please, Check, One, of, the, Following LICA, CONFIDENTIAL and PAGE, OF enter the information the software demands you to do.

It is crucial to put down specific particulars inside the box SECONDARY, DIAGNOSIS, ES

The CHECK, IF, APPLICABLE, TO, OR, ABOVE between, normal, aging, and, dementia and CONTAGIOUS, INFECTIOUS, DISEASE field enables you to point out the rights and responsibilities of all sides.

Fill out the form by checking the next sections: OTHER, CONDITIONS

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