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In this work we consider sub-leading corrections to coherent elastic neutrino nucleus scattering (CEvNS). These corrections are not negligible by power counting since nuclei with large coherent cross sections have sizeable nuclear charges e.g.\ . We find that the corrections are much smaller than naive power counting in would suggest and that Coulomb corrections do not substantially alter predictions for CEvNS in the Standard Model. We comment on similarities to older literature on mesonic and muonic atoms.

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