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Ethics / Consent / Sinusitis / Ethmoidectomy / Endoscopy / Human nose / Rhinology / Medicine / Anatomy


Med Rec. No……………………………………………………… CONSENT FORM Surname:……………………………………………………………
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Document Date: 2007-10-11 23:05:50


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File Size: 180,19 KB

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MedicalCondition

light-headedness / double vision / needlestick/sharps injury / headaches / HIV / disease / sinus infection / cuts on the skin / infection / high blood pressure / constipation / meningitis / nausea / skin rash / heart disease / disorders / sinus infections / /

MedicalTreatment

surgery / /

Person

CONSENT FORM FOR INTRANASAL ETHMOIDECTOMY / /

Position

Date signature Interpreter / surgeon / specialist ENT surgeon / ENT surgeon / INTERPRETER / /

Product

Under / /

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