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Telephone Number: (555-555-1234)
Email Address:
BSCC Heart Valve Serial Number(s):
Implant Position of BSCC Heart Valve(s):
Mitral
Aortic
Other
Implantation Date of BSCC Heart Valve(s) (mm/dd/yyyy):
Has the BSCC valve been replaced?
Yes
No
If "yes", when was it replaced?
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Copyright © 2011
CAC Services Group, LLC
. All Rights Reserved.
Copyright © 2011 CAC Services Group, LLC. All Rights Reserved.