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Submitted URL: http://iryo.cute.coocan.jp/chanhibin88975/navi.cgi?site=121&url=https://form.jotform.com/242975769194072
Effective URL: https://form.jotform.com/242975769194072
Submission: On November 12 via manual from US — Scanned from JP
Effective URL: https://form.jotform.com/242975769194072
Submission: On November 12 via manual from US — Scanned from JP