Practice Information
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Room #
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Nurse
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Biopsy A Site + Description
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Is the patient Immuno-Compromised?
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Biopsy A Location
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Type of Biopsy
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Biopsy A Size and Description
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Margins
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Is this a punch biopsy?
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Was C & D performed?
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Size of Punch Biopsy (mm)
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C & D
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Was a Complete Excision performed?
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Is there a previous biopsy number?
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Is there an additional Dermpath number?
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Previous Biopsy Number
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Histologic Dx
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Dermpath Number
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Type and Volume of Local Anesthesia Used
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Where are we sending this biopsy?
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Clinical DDx
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Does the biopsy site need further Rx?
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What further Rx is needed?
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