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MEDICAL RECORD REVIEWStudent Name: ____________________________ Date: _______

Imaging studies: Radiographs, CT, MRI, etc.

Laboratory Data:

o

CBC:

o

Electrolytes:

o

Culture and Sensitivity:

o

Sputum Gram Stain:

o

Coagulation Study:

Pulmonary Function Testing:

o

FVC

o

FEV1

o

FEV1/FVC

o

Interpretation

Blood Gas Results:

ECG Results:

Miscellaneous Diagnostic Procedures:

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