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Surgeon request checklist 10/14/05 physician: assistant: procedure: patient: patient age: today's date: surgery date: position/approach supine prone
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Start by opening the surgeonrequestformdoc - stlukesonline document on your computer or device.
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Fill in your personal information, such as your full name, date of birth, and contact details, in the designated fields.
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Provide any relevant medical history or previous diagnoses that are necessary for the surgeon's evaluation.
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Clearly state the reason for your surgical request and provide any supporting documentation or test results, if required.
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