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Oral and maxillofacial surgery / Oral surgery / Scar / Keloid / Juvéderm / Restylane / Acne vulgaris / Informed consent / Collagen / Medicine / Surgery / Plastic surgery


PATIENT INFORMATION AND MEDICAL HISTORY Name___________________________________________________ Date___________________ Address________________________________________ City________________ Sate____ Zip_____ Home Phone___
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Document Date: 2013-11-21 00:13:49

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File Size: 1,29 MB

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IndustryTerm

above mentioned services / treatment site / injection site / /

MedicalCondition

Medical Illness / allergy / pain / Allergies / hypertrophy scars / Hypertension / autoimmune disease / acne / Allergic reactions / Photosensi ve Disorder / scars / Lupus / EXPLAIN Keloid / Herpes / Diabetes / injuries / itching / /

MedicalTreatment

Chemical peels / Laser skin resurfacing / Botox / Hysterectomy / /

Position

physician / /

Technology

Laser / /

SocialTag