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 Number2659
Pre-microsuction Otoscopy
Left EarHide Field Value Restricted
Date of treatment//
Left Wax Occlusion %Hide Field Value Restricted
Left Ear Issues
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Right EarHide Field Value Restricted
Right Ear Issues
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Right Wax Occlusion %Hide 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