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List all medications and herbal supplements/remedies that you are currently taking. Name For what Condition Dose/Frequency of use A B C D E F peg dns ocs forms medical history form.doc 11/01 VERIFIED BY EXAMINER 12. NAME DATE CHART UNIVERSITY OF WASHINGTON SCHOOL OF DENTISTRY - MEDICAL AND DENTAL HISTORY GENERAL INFORMATION Male c* Weight lbs. Month Day Year Female d. Height ft. inches e. Highest grade of regular school that you have completed f* Employed Yes No 1. a* Date of Birth b. Gender...
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