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Consent Signed & Pictures Obtained
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Before Picture
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Pre Procedure Checklist
• • •
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Fitzpatrick Skin Type
• • •
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Treatment Number:
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Treatment Log
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Location 1:
• • •
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Other location
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Laser Treatment
• • •
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Settings:
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Location 2:
• • •
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Other location
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Laser Treatment
• • •
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Settings:
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Location 3:
• • •
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Other location
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Laser Treatment
• • •
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Settings:
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Location 4:
• • •
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Other location
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Laser Treatment
• • •
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Settings:
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Notes:
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Post Treatment
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Eye protection on patient and provider throughout treatment:
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Post Treatment Care:
• • •
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Post Treatment Instructions:
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Response:
• • •
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After Picture
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After Picture
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After Picture
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After Picture
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After Picture
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After Picture
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After Picture
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After Picture
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After Picture
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After Picture
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Custom Treatment Plan Recommendations
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Staff to Complete Procedure
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Follow-Up:
• • •
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Follow Up Appointment Reminder
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Care Instructions (electronic & paper)
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