|
Area(s) Examined
• • •
|
Skin Area(s) Examined
• • •
|
|
Procedure(s)
|
|
|
Consent obtained, cleansed, anesthetized with 1%
|
|
|
Site A
|
Size
|
|
Shave biopsy / SEFT / ------mm punch
|
AlCl3/Cautery hemostasis/closure with ___ suture
|
|
Path #
|
Bx Result
|
|
Plan
|
|
|
Site B
|
Size
|
|
Shave biopsy / SEFT / ------mm punch
|
AlCl3/Cautery hemostasis/closure with__ suture
|
|
Path #
|
Bx Result
|
|
Plan
|
|
|
Site C
|
Size
|
|
Shave biopsy / SEFT / ------mm punch
|
AlCl3/Cautery hemostasis/closure with__ suture
|
|
Path #
|
Bx Result
|
|
Plan
|
Ointment / bandage and post care education
|
|
|
|
|
|
|
|
General WNL
|
General Abnormal
• • •
|
|
General Comments
|
|
|
HEENT WNL
|
HEENT Abnormal
• • •
|
|
HEENT Comments
|
|
|
Skin WNL
|
Skin Lesion
|
|
Skin Comments
|
|
|
Neck WNL
|
Neck Abnormal
• • •
|
|
Neck Comments
|
|
|
Cardiovascular WNL
|
Cardiovascular Abnormal
• • •
|
|
Cardiovascular Comments
|
|
|
Lungs WNL
|
Lungs Abnormal
• • •
|
|
Lungs Comments
|
|
|
Abdomen WNL
|
Abdomen Abnormal
• • •
|
|
Abdomen Comments
|
|
|
MSK WNL
|
MSK Abnormal
• • •
|
|
MSK Comments
|
|
|
Breasts WNL
|
Breasts Abnormal
• • •
|
|
Breasts Comments
|
|
|
Neuro WNL
|
Neuro Abnormal
• • •
|
|
Neuro Comments
|
|
|
Extremities WNL
|
Extrem Abnormal
• • •
|
|
Extrem Comments
|
|
