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HAS THE VETERAN HAD AN ORCHIECTOMY Indicate testicle removed Right Left Both Indicate reason for removal Undescended Congenitally underdeveloped Other provide reason for removal VA FORM OCT 2012 21-0960J-2 SUPERSEDES VA FORM 21-0960J-2 DEC 2010 WHICH WILL NOT BE USED. INDICATE ALL TREATMENT MODALITIES USED FOR RECURRENT URINARY TRACT OR KIDNEY INFECTIONS check all that apply No treatment Long-term drug therapy VA FORM 21-0960J-2 OCT 2012 Page 2 H.

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