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CONFIDENTIAL CLIENT INFORMATION Name: Date: Briefly describe your reasons for seeking help:
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Document Date: 2013-08-30 16:36:43
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File Size: 27,50 KB
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MedicalCondition
allergy /
/
MedicalTreatment
birth control /
/
Position
physician /
Medication Dosage Reason PRESCRIBING PHYSICIAN /
/
SocialTag
Psychiatry
Clinical psychology
Psychotherapy
Treatment of bipolar disorder
Over-the-counter drug
Medical prescription
Medicine
Health
Mental health