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Formulario de Salud
Favor llenar el siguiente formulario medico para brindar una atención medica de calidad
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NOMBRE Y APELLIDO
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Your answer
NACIONALIDAD
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EDAD
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Your answer
FECHA DE NACIMIENTO
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MM
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DD
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YYYY
SEXO
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FEMENINO
MASCULINO
OTRO
PESO (KG)
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TALLA (cm)
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