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Name: Date: Referring Doctor: Family Doctor: Pharmacy Phone ...
Indigo Laser Surgery _____ Inguinal (Groin) Hernia _____ (Laser Ablation of Prostate) _____ GYN Colposcopy _____ Culdocentesis _____ HEENT Cataract Surgery _____ Ear Surgery _____ Eye Surgery _____ Facial Surgery _____ Mastoid Surgery _____ Nasal Surgery _____ PEG ... Access Full Source
Name Date - Urology Associates
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In the remainder, the eye disease first becomes apparent after treatment of the hyperthyroidism, more often in patients treated with radioiodine. About one-third were unable to resume their customary work, mainly due to persistent mental problems. ... Read Article
Name: Date: Referring Doctor: Family Doctor
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Patient Please Bring Completed Form Day Of History ...
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Conization Cryosurgery Laser Surgery Repeat Pap Return exam in 3 months None Frequent eye infections Retinal Problems Spots before your eyes N/A Other (vein inflammation) None Other ... Doc Retrieval
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Date: Referring Doctor: Family Doctor - Freedman Urology
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HISTORY FORM 2
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