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DELINEATION OF PRIVILEGES PRACTICE AREA: DERMATOLOGY To request these clinical privileges, the following threshold criteria must be met: 1. Licensed by the State of Iowa as M.D. or D.O., AND 2a. Board
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Anesthesia to request formse is a medical procedure where patients fill out forms to request anesthesia for a surgery or medical procedure.
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Information such as patient's name, date of birth, contact information, medical history, current medications, allergies, anesthesia preferences, and any concerns regarding anesthesia must be reported on anesthesia request forms.
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