113007 - approved by Forms with revisions by Dr Mariano - anesthesia ucsd 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering patient identification details at the top of the form. If available, attach an ultrasound image.
  3. In the Anesthesia Billing Codes section, select the appropriate catheter type and corresponding codes by checking the relevant boxes.
  4. Proceed to fill in Pain Diagnosis Codes by selecting the applicable options for the patient's condition.
  5. Complete the Attending Signature section with your printed name and date, ensuring all required fields are filled accurately.
  6. For each procedure listed, indicate whether it is left or right, and provide details such as start and end times, anesthesiologist's name, and any complications encountered during the procedure.
  7. Finally, review all entries for accuracy before saving or sharing your completed form through our platform.

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