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Same Day Surgery  Form

Same Day Surgery Form

Use a Same day Surgery 0 template to make your document workflow more streamlined.

PCP referred Other How did you hear about our program Number of episodes of otitis media in past 6 months Approximate date of last ear infection Are there concerns about hearing or speech Are there any other otitis media risk factors e.g. daycare/school attendance smoke exposure family history of frequent ear infections school-aged siblings Please note that this Same-day Surgery program is for children 9 months and older and with no major medical problems. If the child does not meet criteria...
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