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SEGUIMIENTO/ FOLLOW-UP FORM
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DATOS DEL PACIENTE/ PATIENT´S INFORMATION
 Fecha de Seguimiento/Date of Follow-up
MM
/
DD
/
YYYY
Numero de Verticalizador/ Stander Number
 Nombre de paciente/Name
 Fecha de Nacimiento/Date of Birth
MM
/
DD
/
YYYY
 Edad/Age
Sexo/Gender
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 Altura (Nota pulgadas o cm)/Height (Note feet and inches or cm)
  Peso (Nota Lib or Kg) /Weight (Note Lb or Kg)
Direccion de Paciente/Patient's Address
Telefono de Paciente/Patients Telephone
 Correo de Paciente/Email
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