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Assignment 9-5. X NEEDED NEEDED. JOHNSON EMILY B 02 12 1963 X JOHNSON ERRON T. 4391 EVERETT STREET X SAME. WOODLAND HILLS XY X . 12345 NEED . NEED NEED. NEED X X NEED. 02 03 1984 X X X X NEED. NEED X X NEED. X. SIGNATURE ON FILE SIGNATURE ON FILE.
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Assignment 9-5 X NEEDED NEEDED JOHNSON EMILY B 02 12 1963 X JOHNSON ERRON T 4391 EVERETT STREET X SAME WOODLAND HILLS XY X 12345 NEED NEED NEED NEED X X NEED 02 03 1984 X X X X NEED NEED X X NEED X SIGNATURE ON FILE SIGNATURE ON FILE 07 15 20XX 02 15 1970 08 21 2010 08 22 2010 PERRY CARDI MD 67805027XX 08 21 2010 08 22 2010 X 790 93 600 1 790 93 600 1 08 07 20XX 08 11 2010 11 1 99212 1 1 1 1 4 28 55 1 1 25678831XX 08 07 20XX 08 11 2010 11 1 99212 1 1 1 1 4 28 55 1 1 25678831XX 08 07 20XX 08 11 2010 11 1 99212 1 1 1 1 4 28 55 1 1 25678831XX 08 07 20XX 08 11 2010 11 1 99212 1 1 1 1 4 28 55 1 1 25678831XX 08 07 20XX 08 11 2010 11 1 99212 1 1 1 1 4 28 55 1 1 25678831XX 08 07 20XX 08 11 2010 11 1 99212 1 1 1 1 4 28 55 1 1 25678831XX 7180561XX X X 9 X X 50 00 50 00 555 4869002 COLLEGE HOSPITAL 4500 BROAD AVENUE WOODLAND HILLS XY 12345 0001 COLLEGE CLINIC 4567 BROAD AVENUE WOODLAND HILLS XY 12345 0001 GENE ULIBARRI MD 083020XX X950731067 3664021CC