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Psychiatry / Clinical psychology / Psychotherapy / Treatment of bipolar disorder / Over-the-counter drug / Medical prescription / Medicine / Health / Mental health


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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allergy / /

MedicalTreatment

birth control / /

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physician / Medication Dosage Reason PRESCRIBING PHYSICIAN / /

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