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  • RAINIER ANESTHESIA ASSOCIATES

    Pediatric Preoperative Medical History
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  • Patient Medical History:

  • Allergies:

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  • Females:

  • Medications:

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  • Parent/Guardian Contact Information:

  • If so, please provide your name and phone number below:

  • The information I have provided above is accurate and complete regarding current and past illnesses, medications (including herbal supplements), and other matters pertaining to the patient's health and complete medical history.

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  • 1002 15th STREET SW, SUITE 215, AUBURN, WASHINGTON 98001 PHONE (253)736-6600 FAX (253)288-2219

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