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Information Includes: General
Name – Address –Telephone # - Email Birthdate - Gender – Height – Weight Photo Language – Religion Diabetic – Yes or No Medical Insurance Information Allergies Food Drug Contact Other Medical Conditions Type Current or Past Medications Name Dosage Frequency Pharmacy – Name – Telephone – Script # Prescribing Doctor Surgeries Type Date Implants/Devices Name – Type Date Serial # Vaccinations Name – Type Date Medical Providers Name – Telephone # Specialty Emergency Contacts Name – Address – Telephone # - Email Relationship
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