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Get Mn Disease Report Card 2018-2024

Ty: State: Phone (home): County: Phone (other): Date of birth: / / Sex: Zip: Male Unknown Female Other: Pregnant? Yes No Due date: / / Unknown Delivery hospital: Occupation: Place of work, school, or child care: Foodhandler? Yes No Unknown Contact with children in child care? Yes No Unknown Patient status at time of reporting: Alive Dead Unknown Date of death: / / Death location: Mobile/cell Race (check all that apply): American Indian or Alaska Nati.

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