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Medical Conditions
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Surgical procedure
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Acknowledgement
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Patient/Parent/Guardian Signature
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Patient Signature
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Witness Signature
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Witness Signature
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Doctor Signature
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Doctor Signature
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Risk Benefits
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Patient/Parent/Guardian Signature
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Patient Signature
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Witness Signature
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Witness Signature
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Doctor Signature
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Doctor Signature
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New Free Draw
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Understood everything
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Patient/Parent/Guardian Signature
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Patient Signature
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Witness Signature
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Witness Signature
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Doctor Signature
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Doctor Signature
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Blood Thinners
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Name of blood thinners
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Blood disorders
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New of bleeding disorder
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Rheumatology Medication
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Name of medication for RA
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Blood Clot
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How was the blood clot treatmet
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Sickle cell
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Drug abuse
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Issues with anesthesia
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Issues with anesthesia
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Wound healing problems
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Problems with wound healing
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