Pre-procedure History and Physical Examination Form
Pre-Procedure History & Physical Examination . One Medical Center Drive, Lebanon, NH 03756 . Page 1 of 2. Original to medical record – Tab 4: Inpatient Notes Approved by OCA 8/08 RM/HIS 11-3-08 Rev. 10/08, 5-2-11 . F-629 . Addressograph . Physical Exam (Complete each item. Explain abnormal.) ... ................
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