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Right 4th toe Left 4th toe Both 4th toes. Right little toe Left little toe Both little toes. Amputation of toes with removal of the metatarsal head. If checked, indicate site and side affected (check all that apply): Right great toe Left great toe Both great toes. Right 2nd toe Left 2nd toe Both 2nd toes. Right 3rd toe Left 3rd toe Both 3rd ... ................
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