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Medical information
Name of child: Ben Adam
Family doctor
Name: Dr George Klooney (male) Address: The Kintown Practice KINTOWN 6111 Telephone: 9111 2389
Medicare Card no: 3334 55667 8
Allergies/conditions: Sometimes has difficulty in swallowing and has occasional seizures.
Signatures sighted by Cybertots staff member? Yes
NOTE: Refer to original form for full details.