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SEX ACCOMPANIED BY AGE Completed previously ALCOHOL, AMOUNT GROUP B STREP HEPATITIS B WEEKS GESTATION TOBACCO or 2ND HAND SMOKE EXPOSURE, AMOUNT HIV POST PARTUM DEPRESSION OTHER MATERNAL PROBLEMS: WHERE DELIVERED OTHER DATE OF Discharge: NO FAMILY MEDICAL HISTORY (any changes or concerns since last visit) ANY ILLNESSES, ACCIDENTS OR HOSPITALIZATIONS: BEHAVIORAL ISSUES AMOUNT PRESCRIBED MEDS Completed previously MEDICAL HISTORY: (any changes or concerns since last visit) DEVELO.

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