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Last Name: Aguirre

First Name: Ravenne

Middle Name: Tatel

Birthdate: January 3, 2018

Age: 5

Street: Unit 502 Onlamco Bldg.

Barangay: Magsaysay Blvd. Sampaloc

City: Manila

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Procedure: 08/12/23- 51, 52, 54, 61, 62, 64, 84 for EXO/ 53,63 Crown Composite/ 75,85 Sealant/ 71,82 LC 08/29/23- under IV CS OP LC 53- facial/ cervical LC 63 Facial / cervical LC 65 Occlusal Exo with ozone and laser (hemostasis) #55, 54, 51, 52, 61, 62, 64, 71, 81, 84 sealant 75/85 OP *check up after 7 days 09/16/23- Check Up

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Retain Record: Yes