Hospital	NEMC BIDMC STELIZ
Patient Lastname
Patient Firstname
Patient ID
Physician	Borden Shucart Wu Heilman Duff
Resident	Wang Lin Kim Cabantog Kryzinksi
Date
Diagnosis
Anesthesia	GETA Local/IV MAC
laterality	Right|Left|
Interspace	L3-4|L4-5|L5-S1|
Annulus incised?
Localizing X-ray?
Disc Appearance
Discectomy Description
Depomedrol?
EBL