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POMA Request
POMA Request
Dr. Mirdamadi
2025-04-18T22:09:58+00:00
Macro
Nuvia SD
Montefiore
Image URL:
Referring Doc:
Pt Name:
DOB:
Age:
Sex
Male
Female
Procedure:
Anesthesia:
LA
IVS
GA Clinic
GA OR
GA vs LA
DOS:
Specialist:
PCP
Cardiology
Pulmonology
Hematology
Oncology/Hematology
Labs:
CBC
CMP
Coags
HbA1c
Tests:
EKG
Echo
Stress Test
PFTs
Clearance:
Yes
No
Unsure
Additional Info:
Clinic:
Address:
City, State:
Zip Code:
Phone Number:
Fax Number:
Output Note
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