Microsuction Notes

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Patient Name (Edit if different to Client Name)Hide Field Value Restricted Hide Field Value Restricted
Client NameHide Field Value Restricted Hide Field Value Restricted
Appointment Number2378
Pre-microsuction Otoscopy
Left EarHide Field Value Restricted
Right EarHide Field Value Restricted
Microsuction Procedure Notes
Procedure Without Incident?Hide Field Value Restricted
Endoscopic?Hide Field Value Restricted
Hearing Test Performed?Hide Field Value Restricted
Post-microsuction Otoscopy
Left Ear (Post)Hide Field Value Restricted
Right Ear (Post)Hide Field Value Restricted
Medical Referral
Medical ReferralHide Field Value Restricted
Additional Practitioner Notes

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Practitioner's Signature