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Get PH CF3 2013

Al Sterilization (as requested by pt.) 18. Schedule the next postpartum follow-up 28. Certification of Attending Physician/Midwife: 19. Certification of Attending Physician/Midwife: I certify that the above information given in this form are true and correct. ___________________________________________________ Signature Over Printed Name of Attending Physician/Midwife Date Signed (Month / Day / Year) 12th .

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