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RESULTS Imaging/Blood-work/Test
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Test Results [blood work/other]
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Upload test/exam/blood-work results
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Upload test/exam/blood-work results
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VENOUS Ultrasound findings
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Free TEXT
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Deep Venous System (Normal):
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Deep Venous System: Positive findings
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Deep System: No DVT (normal)
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Positive findings of...
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Deep System: Competent (normal)
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Right Extenal Ilac Vein
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Left External Iliac Vein
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Right DVT
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Acute vs Chronic
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Right DV Insufficiency
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Left DVT
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Acute vs Chronic
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Left DV Insufficiency
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Superficial Venous exam
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Free TEXT
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No SVT (normal)
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Superficial Veins are Competent (normal)
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Right SV Insufficiency
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Right SVT
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Left SV Insufficiency
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Left SVT
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ARTERIAL ULTRASOUND findings
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Describe impression/results
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ABI findings
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Right ABI value____
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description of results
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Left ABI value____
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description of results
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ABI report (image)
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DIALYSIS ACCESS imaging
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Dialysis Access
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Access type
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Imaging findings and FREE TEXT
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Reference - AVF Maturation Characteristics
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Reference - AVF Maturation definitions
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endoAVF criteria reference
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WavelinQ INFO Reference
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ASSESSMENT
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FREE text/dictate
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GENERAL Assessments
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LOWER EXTREMITY assessment
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LE symptoms _____ attributable to...
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Bilateral _____
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BILATERAL
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R>L or L>R
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Right
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Right______
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Left
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Left ______
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Right > L
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R > L _______
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Left > R
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L > R _______
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Pressure Ulcer augmented by ____
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Others, please specify
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CEAP
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CEAP Treatment Guidelines
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Chronic Venous Insufficiency (CVI) when C2 or above
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Clinical
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CO - NO VISIBLE OR PALPABLE SIGNS OF VENOUS DISEASE:
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C1 - TELANGIECTASES OR RETICULAR VEINS (INCL CORONA PHLEBOECTASIA
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C2 - VARICOSE VEINS>3 MM
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C3 - EDEMA
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C4A - PIGMENTATION (DEPIGMENTATION) OR/AND ECZEMA
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C4B - LIPODERMATOSCLEROSIS OR/AND ATROPHIE BLANCHE
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C5 - HEALED VENOUS ULCER
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C6 - ACTIVE VENOUS ULCER
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S - SYMPTOMATIC
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A - ASYMPTOMATIC
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Etiology
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EC - CONGENITAL
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EP - PRIMARY
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ES - SECONDARY (including PTS)
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EN - NO VENOUS CAUSE
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Anatomy
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AS - SUPERFICIAL VEIN
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AP - PERFORATOR
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AD - DEEP
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AN - NO VENOUS
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Pathophysiology
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PR - REFLUX
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PO - OBSTRUCTION
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PR, O - REFLUX/OBSTRUCTION
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PN - NO VENOUS LOCATION
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S1 - TELANGIECTASIAS/RETICULAR VEINS
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S2 - GSV A/K
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S3 - GSV B/K
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S4 - SSV (LSV)
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S5 - NONSAPHENOUS
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D6/7/8/9 - IVC/CIV/IIV/EIV
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D10 - PELVIC VEINS (GONADAL, BROAD LIGAMENT, ETC)
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D11 - COMMON FEMORAL VEIN
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D12 - DEEP FEMORAL VEIN
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D13 - FEMORAL VEINS (SUPERFICIAL FEMORAL VEIN)
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D14 - POPLITEAL VEIN
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D15 - CRURAL (ANT./POST TIBIAL AND PERONEAL)
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D16 - MUSCULAR (GASTROCNEMIAL, SOLEAL, ETC)
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P17 - THIGH PERFORATORS
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P18 - CALF PERFORATORS
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Indications for SVI treatment.
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Arterial intervention NOT recommended
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Dialysis, Tubes & Lines - focused exam
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Free TEXT
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TUBES & LINES
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Tube integrity and functionality (can be used?)
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DIALYSIS ACCESS
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Dialysis Access
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Access type, if known
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access type [other]
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Abnormal Phys exam findings
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OTHER [i.e. AV fistula R/L]
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General Counseling with patient
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Do NOT use
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Do NOT use
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Do NOT use
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do NOT use
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do NOT use
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