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STATE OF HAWAII DEPARTMENT OF HEALTH 4348 Waialae Avenue, #648 Honolulu, Hawaii[removed]APPLICATION #_________________________
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Document Date: 2014-12-26 16:06:33

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City

Honolulu / /

Company

Immune Deficiency Syndrome / /

MedicalCondition

Glaucoma / epilepsy / wasting syndrome / Crohn's / pain / Severe and persistent muscle spasms / Cancer / HIV / multiple sclerosis / disease / Severe nausea / Seizures / /

Organization

DEPARTMENT OF HEALTH / /

Position

certifying physician / PHYSICIAN / Last First Middle Last First Middle Physician / /

ProvinceOrState

Hawaii / /

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