Get Cbe Results Documentation Form
At Dx N/A Aunt(s): Age(s) at Dx N/A Male Relative(s): N/A specify relationship Related Breast History Last Mammogram: (mo/yr) Last Menstrual Period: (mo/yr) # Breast Biopsy(s): 0 1-2 3 Bx or more date(s): # years HRT Use: 0 1-2 3 yrs or more last used (mo/yr) Augmentation (mo/yr) Reduction (mo/yr.
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