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Breast Worksheet

Name: Lirio Perez Lopez

DOB: 8/19/1968
170 Lb Sex: F

Age: 47 Years

Date: 7/1/16

Height: 54

Conditions: N/A
Medicaments: N/A
Medical History: Hypertension/Diabetes/Cancer/Thyroid
Previous Surgery: 1 C Section
Indications: Routine

Breast:
Right: Normal
Left: Normal

Axila:

Nipple:

Right: Normal

Right: Normal

Left: Normal

Left: Normal

Comments: No nodules, Normal Tissue.

weight:

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