|
Attending Physician:
|
|
|
REFERRING PHYSICIAN:
|
|
|
CHIEF COMPLAINT:
|
|
|
PREPROCEDURE DIAGNOSES:
• • •
|
|
|
POSTPROCEDURE DIAGNOSES:
• • •
|
|
|
PROCEDURE PERF'D: Guidance
|
|
|
PROCEDURE PERF'D: side
|
|
|
ANESTHESIA:
• • •
|
|
|
Anesthesia provider
• • •
|
|
|
PROCEDURE PERFORMED, # series:
|
|
|
P. NOTE: (Omnipaque mL) - Xray ONLY
|
|
|
PROC NOTE: Ultrasound-guidance
|
|
|
FINDINGS/Pre-proc (0-10)
|
|
|
FINDINGS/Post-proc (0-10)
|
|
|
FINDINGS/Post-proc VS (bp&hr)
|
|
|
PLAN:
|
|
