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09/04/06 EJGH000179 EJGH ER Doctor Emergency Room Illness: Dehydration, gastroenteritis The patient has vomiting and diarrhea. He states he passed out at shock to left shoulder by a 110 or 220 volt current when crawling under a house doing repairs. Pt states he felt dazed for a second or two ... Read More
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Date:
2 Date: _____ I hereby authorize a claim to be filed on my behalf under the above group medical policy in the event of an athletic injury. ... Fetch Here
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