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STUDENT ID NUMBER OSIS Sex C] Female Date of Birth (Mont,'vDawYear) a Male NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE DEPARTMENT OF EDUCATION TO BE COMPLETED BY PARENT OR GUARDIAN ... Does the child/adolescent have a past or present medical history of the following? C] Asthma (checkseverity MAF/AsthmaAcfronPlan): [2 Intermittent 12 Mild ... ................
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