Last Updated on 22nd June 2020 by Admin
| Patient Name (Edit if different to Client Name) | Encrypted Field Restricted Encrypted Field Restricted |
|---|---|
| Client Name | Encrypted Field Restricted Encrypted Field Restricted |
| Appointment Number | 248136 |
| Pre-microsuction Otoscopy | |
| Left Ear | Encrypted Field Restricted |
| Date of treatment | // |
| Left Wax Occlusion % | Encrypted Field Restricted |
| Left Ear Issues |
|
| Right Ear | Encrypted Field Restricted |
| Right Ear Issues |
|
| Right Wax Occlusion % | Encrypted Field Restricted |
| Microsuction Procedure Notes | |
| Procedure Without Incident? | Encrypted Field Restricted |
| Endoscopic? | Encrypted Field Restricted |
| Hearing Test Performed? | Encrypted Field Restricted |
| Post-microsuction Otoscopy | |
| Left Ear (Post) | Encrypted Field Restricted |
| Right Ear Issues (Post) |
|
| Right Ear (Post) | Encrypted Field Restricted |
| Right Wax Occlusion % (Post) | Encrypted Field Restricted |
| Medical Referral | |
| Medical Referral | Encrypted Field Restricted |
| Additional Practitioner Notes | Encrypted Field Restricted |
| Practitioner's Signature |