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Page 1/3 - General information

Please enter the following information to start the Medical Record:

ID: (New)
* Name(s):
* Last name:
Mother's surname:
* Gender:
 * Date of birth:
* Blood Group.
* Marital Status:
CURP:
RFC / SSN:
* Nacionality:
* State:
* Municipality:
* Street and number:
* Colony:
* Zip Code:
* Phone:
e-Mail:
 


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