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efta-efta00314175DOJ Data Set 9OtherDS9 Document EFTA00314175
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Unknown
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DOJ Data Set 9
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efta-efta00314175
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PRIORITY PRIVATE CARE
FAMILY HISTORY
Please indicate family members with any of the following conditions:
Alcoholism
Cancer, specify type
Heart disease
Anxiety/depression/suicide
Blood disorders
Genetic disorders
Diabetes
Kidney disease
Anesthesia complications
High cholesterol
High blood pressure
Stroke
Lung problems
Asthma
Alzheimer's disease
Other
170 East 77th Street, New York, NY 10075MMIMIIMMIM
EFTA00314175
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