Hospitalizations / Hospitalizaciones

Please correct the errors described below.

Fill in the information for each time you have been in the hospital. Include any surgeries you have had on an outpatient basis / LIene cada vez que a estado en el hospital

Hospitalization 1

Hospitalization 2

Hospitalization 3

Hospitalization 4

Hospitalization 5

GENETIC SCREENING & TERATOLOGY COUNSELING / DETECCION GENETICO Y CONSEJERIA

Includes patient, baby's father, or anyone in either family / incluya paciente, padre del bebe y familiares

13. MENTAL RETARDATION or AUTISM / RETARDACION MENTAL o AUTISTA

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