| 
               Reason: 
  
  
  
  
 | 
          
            
               PRIOR Endometrial ABLATION? 
  
  
  
  
 | 
          
          
| 
               Prep: 
  
  
  
  
 | 
          
            
               Dilatation? 
  
  
  
  
 | 
          
          
| 
               STENOSIS? 
  
  
  
  
 | 
          
            
               | 
          
          
| 
               Sound: 
  
  
  
  
 | 
          
            
               AV'd / RV'd Position? 
  
  
  
  
 | 
          
          
| 
               # Biopsy Passes 
  
  
  
  
 | 
          
            
               | 
          
          
| 
               Successful? 
  
  
  
  
 | 
          
            
               AMOUNT of TISSUE? 
  
  
  
  
 | 
          
          
| 
               Office F/U: 
  
  
  
  
 | 
          
            
               Surgical Follow-Up? 
  
  
  
  
 | 
          
          
