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Attending Physician:
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REFERRING PHYSICIAN:
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CHIEF COMPLAINT:
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PREPROCEDURE DIAGNOSES:
• • •
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POSTPROCEDURE DIAGNOSES:
• • •
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PROCEDURE PERF'D: Fluor-guided
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PROCEDURE PERFORMED, # series:
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ANESTHESIA:
• • •
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Anesthesia provider
• • •
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Procedure note
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FINDINGS/Pre-proc (0-10)
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FINDINGS/Post-proc (0-10)
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FINDINGS/Post-proc VS (bp&hr)
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PLAN:
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