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Get NYU Pre Employment Physical

Ou ever been pregnant? YES NO If YES, how many pregnancies?_________ Miscarriages?_________ Are your periods regular? YES NO Do you have pain with your periods? YES NO Date of Last Period__________________ Have you ever had a Sexually Transmitted Disease? Gonorrhea Syphilis NEW YORK UNIVERSITY PRE EMPLOYMENT PHYSICAL NAME:_____________________________________________ VACCINATION HISTORY: Last known Tuberculin Skin Test? _________ Results: Negative Positive - If positive was a Chest X ray done.

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