|
INJECTION
|
|
|
Select Physician for Referral
• • •
|
WHICH PHYSICIAN?
|
|
WHAT KIND OF INJECTION?
|
INJECTION TYPE
• • •
|
|
Diagnosis
• • •
|
INJECTION FREE TYPE
|
|
EMG/NCS
|
|
|
Select Physician for Referral
• • •
|
Other Physician
|
|
Diagnosis
• • •
|
Other Diagnosis
|
|
Requested Study
• • •
|
Free Type (notes)
|
|
Other Referral 1
|
|
|
Select Physician for Referral
• • •
|
Other Physician
|
|
Diagnosis
• • •
|
Other Diagnosis
|
|
Eval & Treat
|
|
|
Order
|
Notes
|
|
Other Referral 2
|
|
|
Select Physician for Referral
• • •
|
Other Physician
|
|
Diagnosis
• • •
|
Other Diagnosis
|
|
Eval & Treat
|
|
|
Order
|
Notes
|
|
Salutation - Khurana
|
|
