Histopathology Report

UNIVERSITY OF SOUTHERN MINDANAO
UNIVERSITY HOSPITAL
Telephone No.: (064) 572-2765, (064)572-2934
usmhospital1979@yahoo.com.ph
Kabacan, Cotabato
Philippines
HISTOPATHOLOGY REPORT
DATE: ____________
NAME: _______________________________________________________ AGE:______SEX:_____STATUS:______
(Surname) (First Name) (Middle Name)
ADDRESS:______________________________________________________________________________________
PRE-OP DIAGNOSIS: ______________________________________________________________________________

________________________________________________________________________________________________
BRIEF CLINICAL HISTORY:

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
POST-OP DIAGNOSIS:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
__________________________
PHYSICIAN
UNIVERSITY OF SOUTHERN MINDANAO

UNIVERSITY HOSPITAL
Telephone No.: (064) 572-2765, (064)572-2934
usmhospital1979@yahoo.com.ph
Kabacan, Cotabato
Philippines
HISTOPATHOLOGY REPORT
DATE: ____________
NAME: _______________________________________________________ AGE:______SEX:_____STATUS:______
(Surname) (First Name) (Middle Name)
ADDRESS:______________________________________________________________________________________
PRE-OP DIAGNOSIS: ______________________________________________________________________________

________________________________________________________________________________________________
BRIEF CLINICAL HISTORY:

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
POST-OP DIAGNOSIS:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
__________________________
PHYSICIAN

Histopathology Report

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Histopathology Report

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UNIVERSITY OF SOUTHERN MINDANAO

PRE-OP DIAGNOSIS: ______________________________________________________________________________

BRIEF CLINICAL HISTORY:

UNIVERSITY OF SOUTHERN MINDANAO

PRE-OP DIAGNOSIS: ______________________________________________________________________________

BRIEF CLINICAL HISTORY:

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