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PhilPEN SCREENING LOGBOOK

Burgos, Cabarroguis, Quirino

ALCOHO
BIRTH PUR COMOR- BP/ BP/ BP/ BP/ BP/ BP/
NO. NAME AGE SEX HPN DMMEDICATIONSMOKER L WT HT BMI
DATE OK BIDITIES RBS RBS RBS RBS RBS RBS
DRINKER

10

11

12

13

14
15

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