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Example Of A Health History Report Essay Preview: Example Of A Health History Report Report this essay Health History 1. Biographical Data Date: 10/03/05 Examiner: Name: Phone: Address: Birth date: Birth place: Age: 19 Sex: M Marital Status: Single Occupation: Student Race/ethnic origin: Caucasian Employer: N/A Health Insurance: None 2. Source and Reliability: Client himself,.