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PATIENT INFORMATION Patient Name (First, Last):Prostate MRI Requisition Supplementary FormSunnybrook MAN:This form must accompany the Sunny brook Health Sciences Center Requests for MRI Consultation
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To fill out PR 50048 - Prostate, follow these steps:
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Start by providing your personal information, including your name, address, and contact details.
03
Next, specify the date of the examination or procedure for which the form is being filled out.
04
Indicate your medical history and any relevant information about previous prostate-related issues or conditions.
05
Describe the symptoms or reasons for seeking medical attention related to the prostate.
06
Provide information about any medication or treatment currently being taken for prostate-related concerns.
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Mention any allergies or adverse reactions to medications and anesthesia, if applicable.
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Sign and date the form to acknowledge the accuracy and completeness of the information provided.
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Submit the filled-out PR 50048 - Prostate form to the relevant healthcare provider or medical facility.

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PR 50048 - Prostate is a specific form used for reporting information related to prostate health or treatment.
Individuals who have been diagnosed with prostate issues or are undergoing treatment for prostate conditions are required to file PR 50048 - Prostate.
PR 50048 - Prostate can be filled out by providing accurate information about the diagnosis, treatment, and current status of the prostate health.
The purpose of PR 50048 - Prostate is to collect data on prostate health and treatment outcomes for research and analysis purposes.
Information such as diagnosis details, treatment history, medication usage, and any related symptoms must be reported on PR 50048 - Prostate.
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