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Surgical Case Request (North County Neurosurgery)
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Physician
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Specific Time Period Requested?
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Hospital
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Patient Name, MRN, DOB
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Timing/Urgency
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Operation:
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Levels involved
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Surgical Area/Region
• • •
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Expected Surgical Duration (Positioning through closure)
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Position
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Notes:
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Head Positioner
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Equipment Requests
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Microscope?
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Neuromonitoring?
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Minimally Invasive Tubes? (Metrx or Canyon-Port)
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Navigation System?
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Aquamantys?
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O-Arm or 3D intraop Imaging for navigation?
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Codes
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Anterior Cervical Spine Codes
• • •
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Posterior Cervical Codes
• • •
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Thoracic Spine
• • •
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Lumbar Spine
• • •
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Graft
• • •
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Instrumentation
• • •
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SI Joint
• • •
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Cranial
• • •
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Navigation and ancillary codes
• • •
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Diagnosis Codes
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General Spine Codes
• • •
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General Brain Codes
• • •
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