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Nurse Practitioner Referral Community Cardiac Care Fraser Health 2016

I was asked to make this form by the Newcombe House practice in Chilliwack. It is for Community Cardiac Care. Unfortunately the background is a fax of a fax, and I have asked for but not received an electronic copy from the originators of the form. As such I have scrubbed out all the boxes and underlines and used html code to replace them. JohnR.

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