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Complaints
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Location
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Duration
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Unable to
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Complaints Comments
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Exam, Right Breast
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Exam, Left Breast
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Exam Comments
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Imaging/ Pathology Comments
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Assessment/ Diagnosis
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Assessment/ Diagnosis Side
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Plan
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Plan Side
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Plan Comments
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Surgery Performed at RPH
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Date of Surgery
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Information provided to patient
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Additional Information
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Sincerely,
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Signature
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