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website jjjjjjjjjjjjjjjjjjjjjjjjj JJJJJJJJJJJJJJJJJJJJJJJJJ City, State, Zip JJJJJJJJJJJJJJJJJJJJJJJJJ Contact Name JJJJJJJJJJJJJJJJJJJJJJJJJ Jobsite Phone # JJJJJJJJJJJJJJJJJJJJJJJJJ Est jjjjjjjjjjjjjjjjjjjjjjjjj ❑ No ❑ Yes JJJJJJJJJJJJJJJJJJJJJJJJJ Bleeding tendency ❑ No ❑ Yes JJJJJJJJJJJJJJJJJJJJJJJJJ Diabetes ❑ No ❑ Yes
jjjjjjjjjjjjjjjjjjjjjjjjj JJJJJJJJJJJJJJJJJJJJJJJJJ Right Comment: JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ Anterior □Y □N JJJJJJJJJJJJJJJJJJJJJJJJJ Weight gain or loss over 10 lbs in the Eye foreign body sensation □Y □N JJJJJJJJJJJJJJJJJJJJJJJJJ Eye pain or JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJ JJJJJJJJ Medication allergiesJJJJJJJJJJJJJJJJJJJJJJJJJJJEnvironmental JJJJJJJJJJJJJJJJJJJJJJJJJ
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