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Get Penn Medicine Kidney Living Donor Referral Form

Mary care physician or doctor? __________________ 2. Has a physician ever told you that you have high blood pressure? ☐ Yes ☐ No ☐ Unknown 3. Does anyone in your family have high blood pressure? ☐ Yes ☐ No ☐ Unknown 4. Has a doctor ever told you there are problems with your blood sugar? ☐ Yes ☐ No ☐ Unknown 5. Does anyone in your family have diabetes or pre-diabetes? ☐ Yes ☐ No ☐ Unknown 6. Has a doctor ever told you there is a problem with your heart such as a.

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