Sample, Sammy G ST0001

Followup Form 1234567890


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Ordering Information




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Smoking History

Form Reported Date Pack Years Cumulative
Intake 2/11/2017 32.5 32.5
Followup 08/15/2018 0.3 32.8
Followup 08/15/2019 0.5 33.3
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Communication about results

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