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Cosmetic Surgery Procedure(s)
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Cosmetic Surgery Comments
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Reconstructive Surgery Procedure
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Reconstructive Surgery Comments
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Medical Procedure(s)
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Medical Procedure Comments
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Sientra Silicone Implant Size
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Size Comments
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Allergan Silicone Implant Size
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Size Comments
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Mentor Silicone Implant Size
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Size Comments
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Allergan Saline Implant Size
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Size Comments
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Sientra Shaped Classic Moderate
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Size comments
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Allergan Style 410 Implant Size
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Height - Projection Type shape
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Size comments
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Different Sizes Left vs Right
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Left vs Right sizes comments
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Silicone gel booklet given
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Silicone booklet Comments
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Off label silicone gel
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Off label Comments
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Reduction Waiver
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Insurance (left / right ) grams
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Risks/Safety
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Comments Risks/Safety
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SQ Heparin/Lovenox Considered
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ANYTHING PENDING BEFORE Sx
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PENDING COMMENTS >>>
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ALL PENDING COMPLETED
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Balance Paid
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Balance $ comments
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Insurance Approved
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Insurance Comments
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Balance not paid in full
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Balance $ comments
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Insurance not approved
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Insurance notes
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General Instructions
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General Instruction Comments
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Referrals
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Referral Comments
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Labs
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Comments
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Radiology
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Radiology Comments
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Diet
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Diet Comments
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Education
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Education Comments
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PT Recommendations
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PT Recommendation Comments
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Home Health
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Home health Comments
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