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Right or Left Knee
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"On" if X-ray's were NOT taken here
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Date of Non-ROC X-ray's taken
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Indications for X-ray's taken
• • •
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Other Indications
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Alignment
• • •
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Other Alignment
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Joint Space
• • •
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Other Joint Space
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Patella Location
• • •
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Other Patella Findings
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Bone Findings
• • •
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Other Bone Findings
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Assessment (select all that apply)
• • •
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Other Assessments
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