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DEPARTAMENT OF OBSTETRICS AND GYNECOLOGY

SHYAM SHAH MEDICAL COLLEGE AND ASSOCIATED G.M.H , S.G.M.H , REWA

MINOR OT SHEET
(GYNECOLOGY/OBSTETRICS)

NAME - W/O - AGE- UNIT-


ADDRRESS - REG. NO. –
OPD NO.-

D&C/D&E/POLYPECTOMY/BIOPSY/RESUTURING/FORCEPS&VENTOUSE/
EUA/PACK REMOVAL

SURGEON’S SIGN-
CONSENT FOR PROCEDURE

PATIENT’S SIGN

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