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Mink Information
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<< Which Location?
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MDRH Referral
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Other Radiology Location
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STAT
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Radiology Co. Please assist in Authorization
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ORDER 1
• • •
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Side
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Body Part
• • •
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WITH CONTRAST?
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Creatine Level (include date)
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Other Order
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Diagnosis
• • •
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Other Diagnosis/ Rule out
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Notes
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For Pre-Op Assessment?
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Has Patient Tried PT?
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< How long?
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Give patient CD?
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Give Patient Films (MDRH only)
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ORDER II
• • •
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Side
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Body Part
• • •
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WITH CONTRAST?
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Creatine Level (include date)
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Other Order
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Diagnosis
• • •
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Other Diagnosis/ Rule out
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Notes
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For Pre-Op Assessment?
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Has Patient Tried PT?
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< How long?
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Give patient CD?
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Give Patient Films (MDRH only)
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ORDER 3
• • •
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Side
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Body Part
• • •
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WITH CONTRAST?
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SHUNT DIAL SETTING
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Creatine Level (include date)
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Other Order
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Diagnosis
• • •
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Other Diagnosis/ Rule out
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Notes
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For Pre-Op Assessment?
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|
Has Patient Tried PT?
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< How long?
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Give patient CD?
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Give Patient Films (MDRH only)
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Salutation - Khurana
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