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This information is requested by your anesthesiologist. Please fill out this side as completely as you can. If you have any questions, please note them to discuss with your anesthesiologist. Name Age Height Weight
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Document Date: 2012-10-10 19:01:16
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This information is requested by your anesthesiologist. Please fill out this side as completely as you can. If you have any questions, please note them to discuss with your anesthesiologist. Name Age Height Weight