Normal Physical Exam
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Date of Surgery
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Other Date
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PREOP Dx
• • •
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PreOp Dx Free text
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Post Op Dx
• • •
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Post Op Dx Free Text
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Procedure
• • •
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Procedure Free Text
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Anesthesia
• • •
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Blood Loss
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Volume Injected
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Indications
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Shaft and Glans - Circumcised
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Shaft and Glans - Uncircumcised
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Shaft Only - Circumcised
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Shaft Only - Uncircumcised
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Glans Only
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Scrotum
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