| NAME | MAILING ADDRESS-STREET | MAILING ADDRESS-CITY | MAILING ADDRESS-STATE | MAILING ADDRESS-ZIP | SSN# | CASE MANAGER | CX TX NEED | CX TX NEED DUE DATE | DES DAUGHTER | PAP REGIMEN | PAP REGIMEN START DATE | BR TX NEED | BR TX NEED DUE DATE | DATE OF FIRST ENCOUNTER | REFERRAL SOURCE | FAMILY HX OF BR CA | DATE INACTIVE | BREAST TX FACILITY | CERVICAL TX FACILITY | CST | MATERNITY CARE COORDINATOR | NOTES | APPOINTMENTS | COMPLETE ADDRESS | PREGNANCY STATUSES | LACTATION STATUSES |
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