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Plastic surgery / Breast reconstruction / Tissue expansion / Breast / Mastectomy / Breast implant / Breast augmentation / Medicine / Surgery / Breast surgery


Med Rec. No……………………………………………………… CONSENT FORM Surname:……………………………………………………………
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Document Date: 2007-10-11 23:05:55

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File Size: 186,98 KB

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MedicalCondition

light-headedness / scars / infection / scar / numbness / constipation / needlestick/sharps injury / nausea / HIV / skin rash / disorders / /

MedicalTreatment

breast reconstruction / mastectomy / incision / antibiotics / /

Position

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

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