Hospital Child City / American College / American College of Traditional Chinese Medicine Community Clinic Initial Health History Form Patient Name / Chinese Medicine Community Clinic Initial Health History Form American College of Traditional Chinese Medicine Community Clinic / The ACTCM Community Clinic / American College of Traditional Chinese Medicine Community Clinic Initial Health History Form Notice / Clinic Medical Staff / ACTCM Community Clinic / American College of Traditional Chinese Medicine Community Clinic Initial Health History Form Have / American College of Traditional Chinese Medicine Community Clinic Initial Health History Form Informed Consent / The American College of Traditional Chinese Medicine / Clinic By / American College of Traditional Chinese Medicine Community Clinic Initial Health History Form Policy / American College of Traditional Chinese Medicine Community Clinic Initial Health History Form PATIENT INFORMATION / /
oral contraceptives / moxibustion / Traditional Chinese Medicine / acupuncture points / acupuncture / counseling / massage / /
Organization
U.S. Department of Health and Human Services / American College / Community Clinic Initial Health History Form American College of Traditional Chinese Medicine Community Clinic / Personal Representative’s Authority / The American College / /
Person
Tracy Tognetti / / /
Position
Physician / representative / Health care source Physician / Witness/Translator / /
American College of Traditional Chinese Medicine Potrero Clinic