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Birth control questionnaire - Salter Ferguson, LLC

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The document is a Birth Control Questionnaire designed to collect detailed information from an injured person regarding their personal details, medication usage, medical events related to the use of birth control products, and insurance information. It includes sections for the injured person's information, the person completing the form, medication history, physician and pharmacy details, medical events experienced while using the medication, additional information about legal representation, and insurance coverage at the time of injury.

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