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Page 1: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 2: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 3: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 4: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 5: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 6: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 7: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 8: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

Page 9: tampahealthcenter.com...Mammogram PCOS Dr. Dr. Dr. PAP Cancer (Type and Treatment) Other (Please Specify) When was your last: Colonoscopy Menstrual Cycle PAST SURGICAL HISTORY: Date

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