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Blank Form HPN and DM Masterlist
Blank Form HPN and DM Masterlist
BHS- CANLAPWAS
PUROK-
Put an "X" on the corresponding column
Date of
Sex NHTS / LATEST MEDICATIONS TAKEN
Birth
No. Last Name, First Name, Middle Name Age Address NON MONITO HPN DM
NHTS RING
M/F (mm/dd/yyyy Amlodipine Losartan Metoprolol Metformin Others