Salem Laser & Surgery Center, LLC
East
Lapour
Dodd
Patient Last, First Name
Surgery Date
Eye
Pterygium Excision without Graft
Pterygium Excision with Amniotic Graft
Pterygium Excision with Conjunctival Auto Graft
Mitomycin
5FU
Tisseel Glue
Retrobulbar Block
Tri-Moxi
OMNI
Notes
Patient Label
PRINT FORM