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Tissue expansion / Scar / Mastopexy / Medicine / Plastic surgery / Surgery


Med Rec. No……………………………………………………… CONSENT FORM Surname:……………………………………………………………
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Document Date: 2007-10-11 23:05:48


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File Size: 176,25 KB

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MedicalCondition

SCAR / constipation / nausea / skin rash / HIV / lightheadedness / disorders / permanent scar / Hepatitis B / /

MedicalTreatment

antibiotics / /

Position

plastic surgeon / plastic surgical specialist / signature Interpreter / doctor Date Interpreter / specialist surgeon / surgeon / INTERPRETER / /

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