Adult
CLINIC USE ONLY
Hep A
Hep B
Flu
Tdap
HPV
Alias __________________________________________________________________________________
Birth State: ___________________ Facility Born: __________________ Birth Order: ____________
/ Native American / Alaskan /
Cell Phone:
(Teléfono celular)
Cell Phone Provider:
(Teléfono celular del proveedor)
Uninsured
Underinsured
Medicaid Package E
Medicaid
Age:
Intake initials:
Fully Insured
Other
Nurse initials:

ここ最近の作業まとめ M1 東 直 シンチ二枚を使って宇宙線のポジション