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Exit Site / Tunnel / Peritonitis Infection Update Form
Code:
Mobile:
Name:
PD Fluid TLC:
PD Fluid DLC:
Neutrophils:
Lymphocytes:
Eosinophils:
Monocytes:
Basophils:
Culture report
Organism found:
Organism Name:
Others:
PD Fluid / Swab Culture
Outcome Date:
Gram Stain:
OutCome:
Loss Reason:
Associated Reason:
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