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Nexa es verdadera y correcta. Firma del paciente o persona responsable Fecha HISTORIA DENTAL La raz n de su visita hoy No Si 1. Es esta la primera visita al dentista de de su hijo(a)? ? ? No Si 3. Toma su hijo(a) gotas o tabletas con fluoruro o vitaminas con fluoruro? ? ? No Si si es No, expliqu.

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