| PATIENT | TYPE OF DEFICIENCY | EVENT DATE | ADMISSION | LOCATION | DIVISION | SPECIALTY | SERVICE | PRIMARY PHYSICIAN | ATTENDING PHYSICIAN | STATUS | PHYSICIAN RESPONSIBLE | INPATIENT REPORT? | PHYSICIAN FOR DEFICIENCY | DATE DICTATED | DICTATED BY | DATE TRANSCRIBED | TRANSCRIBED BY | DATE SIGNED | SIGNED BY | DATE REVIEWED | REVIEWED BY | COMMENTS |
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