Goodman Pediatrics

New Patient History

Please correct the errors described below.

Birth History

Medical History

Family History

mother (M) father (F) brother (B) sister (S) aunt (A) uncle (U)
mother's mother (MM) mother's father (MF) father's mother (FM) father's mother (FF)

Which family members have the following? (please indicate using the above abbreviations)

Tuberculosis Exposure:

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