Case File
efta-efta00296174DOJ Data Set 9OtherWOODSON C. MERRELL, M.D. PLLC
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00296174
Pages
1
Persons
0
Integrity
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Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
WOODSON C. MERRELL, M.D. PLLC
44 EAST 67th STREET
NEW YORK, NEW YORK 10065
Telephone: (212) 535-1012
Fax: (212) 535-1172
Checklist for New Patient Inquiries
Name:
Age:
DOB:
Address:
Phone:
Email:
Referred by:
Current Primary Physician:
Chief Complaints:
Brief Medical History:
EFTA00296174
Technical Artifacts (3)
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Fax
Fax: (212) 535-1172Phone
(212) 535-1012Phone
(212) 535-1172Forum Discussions
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