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Diagnostic Studies
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Knee Imaging
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Hip Imaging
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Ankle Imaging
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Foot Imaging
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Lumbar Spine Imaging
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EMG/NCV
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Ultrasound
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Knee Imaging
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X-Rays - Knee
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MRI - Knee
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CT Scan - Knee
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Knee Radiographs
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Date
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Normal Knee Radiographs
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Knee Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Imaging
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Outside/[+] Findings
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Date
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Normal Knee Radiographs
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Knee Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Imaging
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Outside/[+] Findings
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Date
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Normal Knee Radiographs
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Knee Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Imaging
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Outside/[+] Findings
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Date
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Normal Knee Radiographs
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Knee Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/[+] Findings
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Knee MRI
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Date
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Impression
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Date
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Impression
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Date
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Impression
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CT Knee
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Date
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Impression
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Hip Imaging
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X-Rays - Hip
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Date
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Normal Hip Radiographs
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Hip Radiographs [+]
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Radiographs [+]
• • •
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Outside/Abnormal Findings
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Additional Hip X-rays
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Date
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Normal Hip Radiographs
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Hip Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/[+] Findings
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Additional Hip X-rays
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Date
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Normal Hip Radiographs
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Hip Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Hip X-rays
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Outside/[+] Findings
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Date
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Normal Hip Radiographs
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Hip Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/[+] Findings
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MRI - Hip
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Date
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Impression
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Date
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Impression
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CT Scan - Hip
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Date
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Impression
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Date
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Impression
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Ankle Imaging
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X-Rays - Ankle
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Date
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Normal Ankle Radiographs
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Ankle Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/ [+] Findings
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Additional Ankle X-rays
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Date
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Normal Ankle Radiographs
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Ankle Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/[+] Findings
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Additional Ankle X-rays
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Date
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Normal Ankle Radiographs
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Ankle Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Ankle X-rays
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Outside/[+] Findings
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Date
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Normal Ankle Radiographs
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Ankle Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/[+] Findings
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MRI - Ankle
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Date
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Impression
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Date
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Impression
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CT Scan - Ankle
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Date
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Impression
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Date
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Impression
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Foot Imaging
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X-Rays - Foot
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Date
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Normal Foot Radiographs
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Foot Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Foot X-rays
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Outside/[+] Findings
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Date
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Normal Foot Radiographs
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Foot Radiographs [+] Side
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Radiographs [+]
• • •
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Additional Foot X-rays
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Outside/[+] Findings
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Date
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Normal Foot Radiographs
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Foot Radiographs [+] Side
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Radiographs [+]
• • •
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Outside/[+] Findings
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MRI - Foot
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Date
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Impression
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Date
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Impression
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CT Scan - Foot
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Date
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Impression
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Date
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Impression
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Lumbar Spine Imaging
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X-Rays - Lumbar Spine
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Date
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Normal Lumbar Spine Radiographs
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L-Spine Radiographs [+] Side
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Lumbar Spine Radiographs [+]
• • •
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Outside/ [+] Findings
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Additional L-Spine X-rays
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Date
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Normal Lumbar Spine Radiographs
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Outside/Abnormal L-Spine Radiographs
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Lumbar Spine Radiographs [+]
• • •
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Outside/ [+] Findings
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Additional L-Spine X-rays
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Date
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Normal Lumbar Spine Radiographs
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Outside/Abnormal L-Spine Radiographs
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Lumbar Spine Radiographs [+]
• • •
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Outside/ [+] Findings
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MRI - Lumbar Spine
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Date
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Impression
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Date
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Impression
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Date
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Impression
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Date
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Impression
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CT Scan - Lumbar Spine
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Date
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Impression
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Date
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Impression
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EMG/NCV
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Date
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Comments/Impression
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Date
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Comments/Impression
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Ultrasound
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Date
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Impression
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Date
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Impression
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