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INJECTION
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Select Physician for Referral
• • •
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WHICH PHYSICIAN?
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WHAT KIND OF INJECTION?
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Diagnosis
• • •
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INJECTION FREE TYPE
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EMG/NCS
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Select Physician for Referral
• • •
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Other Physician
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Diagnosis
• • •
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Other Diagnosis
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Requested Study
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Free Type (notes)
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Other Referral 1
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Select Physician for Referral
• • •
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Other Physician
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Diagnosis
• • •
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Other Diagnosis
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Eval & Treat
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Order
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Notes
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Other Referral 2
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Select Physician for Referral
• • •
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Other Physician
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Diagnosis
• • •
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Other Diagnosis
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Eval & Treat
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Order
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Notes
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