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Mammography Forms
Physician? _______________Findings:_________________________
REASON FOR TODAY’S EXAM:
□ Yearly routine
□ Lump
□ Skin Changes
□ Follow-up for problem/biopsy
□ Nipple discharge
□ Swelling
□ Additional imaging from prior/outside study
□ Soreness
□ Pain
□ Other: ___________________________________________________________________________
PREVIOUS BREAST SURGERY:
If Yes, Continue Answering:
□ Yes □ No
When?
Result
Breast Biopsy:
□ Aspiration □ Core Needle Bx □ Surgical Bx
□ RIGHT □ LEFT...
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