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VELEZ – FAJARDO CHILDREN’S CLINIC

Suite 206 GSDH Medical Suites


General Santos Doctors Hospital
National Highway, Gen. Santos City
Tel. No.: 250-2888 L0C 2206
Cel #: 0933-545-3461

Name of Patient: __________________________ Age: ____ Sex: ____

Address: _________________________________Date: ____________

______________________________
BERNARDITA H. VELEZ-FAJARDO,MD
LICENSE NO: 0080571
PTR NO:
Next visit on: __________

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