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Text File  |  1991-09-17  |  10KB  |  1 lines
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                          ╔══════════════════════════╗                                                                                                                                              ║  PATIENT CEA RESULT LOG  ║                                                                                                                                              ╚══════════════════════════╝                                                                                                                                                                                                                                                                                              ╔═════════════════════════════════════════╦═══════════════════════════════════╗                                                                                           ║Patient Name:                            ║  Med. Record #:                   ║                                                                                           ╠═════════════════════════════════════════╬═══════════════════════════════════╣                                                                                           ║Date of Birth:                           ║  Doctor:                          ║                                                                                           ╚═════════════════════════════════════════╩═══════════════════════════════════╝                                                                                                                                                                                                                                                                     ╔═════════════════════╤════════════════╦═════════════════════╤════════════════╗                                                                                           ║ CEA RESULT (ug/ml): │ Date:          ║ CEA RESULT (ug/ml): │ Date:          ║                                                                                           ╠═════════════════════╪════════════════╬═════════════════════╪════════════════╣                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╟─────────────────────┼────────────────╫─────────────────────┼────────────────╢                                                                                           ║                     │                ║                     │                ║                                                                                           ╚═════════════════════╧════════════════╩═════════════════════╧════════════════╝