| Document Date: 2012-12-05 16:43:32
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MedicalCondition Persistent cough / Cerebral Palsy / cut / Allergies / Latex allergy / Cancer / diseases / HIV / AIDS / Fainting / Epilepsy / Arthritis / Hepatitis / Measles / Chicken Pox / Cough / Chronic Sinusitis / serious illness / Active Tuberculosis / Anemia / Diabetes / injuries / disorders / Asthma / Ear Aches / / MedicalTreatment Premedication / Immunizations / blood transfusion / antibiotics / / Organization American Dental Association / / / Position physician / receptionist / dentist / / Product penicillin / / URL www.adacatalog.org / / |
Child Health/Dental History Form Patient’s Name Nickname FIRST