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Which knee is being treated?
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How long have you had this knee pain?
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Current pain level (1-10)
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Active infection signs? (fever, redness, warmth, open wound near knee)
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Currently taking blood thinners or anticoagulants?
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Known allergy to local anesthetics? (e.g. lidocaine, bupivacaine)
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New SwPrior reaction to a joint injection or injectable medication?itch
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Known allergies (select all that apply)
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Previous treatments tried (select all that apply)
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Patient Consent
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Signature
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