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DATE OF PROCEDURE:
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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 NAME/SIDE
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PROCEDURE NAME/# series
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With Ultrasound guidance
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Procedure/Needle type:
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PROCEDURE Note/LA
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Procedure Note/Steroid
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Procedure Note/Ultrasound use
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Procedure Note/Conclusion:
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FINDINGS/Pre-proc (0-10)
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FINDINGS/Post-proc (0-10)
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PLAN:
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