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Echocardiogram - Patient Name Auto
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Date of Study
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Quality of study
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Name / Age: Auto - Enter: Days / Months / Years
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Select Reason for study
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Type - Reason for study
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Normal 2-D Evaluation
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Abnormal 2-D Evaluation - Type/Dictate
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LV Funtion
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Yes - FS No - EF
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FS or EF #
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Additional 2-D Selections
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Additional 2-D - Type/Dictate
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Normal Doppler / Color Doppler
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Abnormal Doppler / Color - Type/Dictate
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Tricuspid / Pulmonary Insufficiency
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RV / PA Pressure
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Other Doppler - Type/Dictate
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Normal Echo
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Impression - Type/Dictate
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Other Information - Type/Dictate
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Recommend appt
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Attached to measurement sheet
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Date of Dictation
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