| Document Date: 2007-10-11 23:05:52
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Facility HOSPITAL Med Rec / / MedicalCondition light-headedness / hernia / scar / pain / numbness / cut / strain on the wound before the tissues / inguinal hernia / HIV / needlestick injury / infectious diseases / infection / ischaemic orchitis / high blood pressure / inflammation / constipation / nausea / skin rash / heart disease / permanent scar / Hepatitis B / / MedicalTreatment antibiotics / / Position specialist surgeon / surgeon / INTERPRETER / /
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Med Rec. No……………………………………………………… CONSENT FORM FOR INGUINAL HERNIA REPAIR