div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 6button div class=ts-image amp-img class=ts-thumb alt=Page 6: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails6jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 7button div class=ts-image amp-img class=ts-thumb alt=Page 7: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails7jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 8button div class=ts-image amp-img class=ts-thumb alt=Page 8: irp-cdnmultiscreensitecom · 2019 11 13 · Childs Name: Date of Birth Completed by: Adelita Segovia MD Daniel B Reising MD Child and Adolescent Psychiatry General Psychiatry src=https:reader034vdocumentinreader034viewer2022052012602960fc3a41d64cde664090html5thumbnails8jpg width=142 height=106 layout=responsive amp-img divdiv