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Cerebral shunt / Neurology / Dosage forms / Shunt / Hydrocephalus / Lumbar-peritoneal shunt / Intravenous therapy / Port / Catheter / Medicine / Implants / Medical equipment


Med Rec. No………………………………………………………… CONSENT FORM Surname:……………………………………………………………
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Document Date: 2007-10-11 23:05:54


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File Size: 211,45 KB

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MedicalCondition

chest infection / hernia / pain / cut / needlestick/sharps injury / pulmonary embolus / injury / headaches / hydrocephalus / deep vein thrombosis / brain causing paralysis / heart attack / HIV / seizures / strain / infection / high blood pressure / memory loss / constipation / nausea / skin rash / heart disease / disorders / /

MedicalTreatment

cannula / catheter / surgery / physiotherapy / drainage / catheters / blood transfusion / Antibiotics / /

Position

VP / Date Signature Interpreter / neurosurgeon / INTERPRETER / specialist neurosurgeon / VP shunt / /

Product

Under / /

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