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Get RBC 83738 2008-2024

Ry diagnosis: (if psychiatric, indicate the DSM-IV, including all axes/if cardiac, include Cardiac Class and Blood Pressure at last visit) b) Secondary diagnosis: (including complications) c) Current symptoms which prevent or limit the patient’s ability to work: d) Objective findings. Include the name of objective tests, dates performed and the results: e) If condition is due to pregnancy, what is the expected date of delivery? (MM/DD/YYYY) TREATMENT 2. Date of latest visit: 3. Ha.

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