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Cancer screening / Plastic surgery / Breast cancer / Consent / Mammography / Lumpectomy / Breast lump / Surgery / Mommy makeover / Medicine / Breast surgery / Ribbon symbolism


Med Rec. No………………………………………………………… CONSENT FORM Surname:………………………………………………..……………
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Document Date: 2007-10-11 23:05:51

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File Size: 176,36 KB

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MedicalCondition

chest infection / light-headedness / bruise / cuts / scar / pain / cut in the skin / pulmonary embolus / deep vein thrombosis / heart attack / HIV / needlestick injury / infectious diseases / pulmonary embolism / strain / high blood pressure / constipation / nausea / skin rash / heart disease / Hepatitis B / /

MedicalTreatment

physiotherapy / antibiotics / /

Person

CONSENT FORM FOR BREAST LUMPECTOMY / /

Position

specialist general surgeon / Date signature Interpreter / surgeon / general surgeon / INTERPRETER / /

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