All applicants must pay a one-time fee of $100, even those under the age of 18. If you are rejected from the program for any reason, you will not get your $100 back. To hedge your bets, make sure to get your fee reimbursed by a credit card or loyalty program.
Surgical Consent for Breast Biopsy. Diagnosis: â¢ You have been diagnosed with a breast mass. Any noticeable change, thickening or localized swelling in your breast that wasnât. there before can be considered a mass. Most women will experience some type of breast mass in their lifetime. Name of Procedure/Treatment:
1 the surgeon's signed request for post-op pain management (a Medicare requirement). 2  description of the procedure performed. 3  date the procedure was performed. 4  signature of the person performing the procedure; and. 5  a statement that the block was performed pre-or post-anesthesia in a place other than the operating room.