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The clipping this text was read from
The clipping this text was read from

MEMBERSHIP

MED CARD PERSONAL MEDICAL 4 INSURANCE DATA ►

JOHN A. SMITH

— 100 PARK PLACE

ANYTOWN, USA 12345 Culpeper Memorial Hospital Foundation Culpeper Memorial Hospital Foundation Inc Sunset lane PO Bo* 803 Culpeper Virginia 22701 (703)825 28)1

MEDICAL HISTORY MICROFILMYOUR

PERSONAL IDENTIFICATION

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