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Medical information change
Texas Telemedicine Doctor
Use this form to tell us about changes in your medical information (not personal information). Examples include diagnoses, medications, allergies, family history, etc.
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Last name
*
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Date of birth
*
MM
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DD
/
YYYY
Please tell me what medical information has changed and include the new information
Example: I went to the ER and was diagnosed with diabetes several weeks ago
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