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HPI ON
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HPI Comments
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TUMOR: Biopsy proven...
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Tumor Comment
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COSMETIC BREAST complaints
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Desires
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COSMETIC current cup size
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Desired Cup Size
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Comments
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CAPSULAR CONTRACT complaints
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implant changes
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Onset of capsules __ years ago
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augmentaion __ years ago
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Denies pain
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Pain in implants
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which side is pain worse?
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Accolate
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Difficulty exercising /interf activity
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Comments
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Contemplating Procedure?
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Why this procedure today?
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Additional Comments
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BREAST REDUCTION
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Current cup size
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Breast reduction comments
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ABD-EXTREM-TRUNK complaints
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Desires
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Complains of excess fat - Trunk
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Complains of excess fat - Extremities
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Major Weight Loss?
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Pounds (lb) weight loss?
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Stable weight for 6 months
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Additional comments
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HERNIA COSMETIC
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HERNIA INSURANCE
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History of prengnancy
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History of C-section
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Insurance Comments
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GYNECOMASTIA - Insurance
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GYNECOMASTIA - Cosmetic
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Steroid, Medications, Endocrine?
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Onset after puberty
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Cosmetic Comments
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PANNICULECTOMY
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Major Weight Loss?
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Type of weight loss surgery?
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Pounds (lb) weight loss?
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Date of weight loss surgery
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Stable weight for 6 months
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Panniculectomy comments
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FACE Initial complaints
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FACE Desires
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FACE Additional Comments
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BROWS Initial complaints
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BROWS Desires
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BROWS Additional Comments
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EYES Initial complaints
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EYES Additional Comments
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EYES Desires
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EARS Initial complaints
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Symmetry
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EARS Additional Comments
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PRE-OP EVALUATION complaints:
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PRE-OP Comments
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