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ADULT MEDICAL HISTORY FORM Name Texas Family Physicians

ADULT MEDICAL HISTORY FORM Name Texas Family Physicians

Use a ADULT MEDICAL HISTORY FORM Name Texas Family Physicians 0 template to make your document workflow more streamlined.

MEDICATIONS / OTHER Immunizations Hepatitis A Hepatitis B MMR Varicella IPV Dtap/Td/TdaP Pneumovax-23 Gardasil Zostavax PPD GYN Women only Age menses began Full Term Premature Still Born Last menstrual period Abortion/Miscarry Pregnancies Living children IV. An Accounting of Disclosures You have the right to request a list of the disclosures of your health information we have made outside of our practice that were not for treatment payment or health care operations. Any psychotherapy notes...
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