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Get and Sign Request for Laboratory Study Form UW School of Dentistry Dental Washington 2016-2022

Get and Sign Request for Laboratory Study Form UW School of Dentistry Dental Washington 2016-2022

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Number because it serves as a unique identifier. I. Email and or Website NPI No. Doctor s Address Number Street Suite Phone City State ZIP Fax No. M EDIC AL INFORMATION Description of Lesion Location Size Color Symptoms Associated Findings and Past History Previous Biopsy Case No. Smoking and Alcohol Use optional Has the patient ever used tobacco products Yes No Number of years Current use What type Cigarette Pipe/Cigar Smokeless Beer Wine Mouthwash brand Other Toothpaste brand PROC EDU...
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