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EFTA00063517
narcy • Uve birth LI Soo-Wane= termination U Induced termination • Noce Did tobacco use contribute to death? U Yes J No ..i Probst* ),O Unk. For infant under 1 year: Name and address of hospital or ether place of beth EFTA00063532 • NAMEOF DECEDENT: Epstein, Jeffery MEDICAL OTAA4N
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