▲ ▼ Cell #: Other Transgendered
Consider Examination Preparation below
▲ ▼ ▲ ▼ EDC: ▲ ▼ Physician Fax Copy To:
Subject:

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MedRay US/XRAY eForm V7_May20_2020, a collaboration between Drs. Herbert Chang and John Yap, is licensed under a GPL. Please consider supporting OSCAR BC.

PROCEDURES

OBSTETRICAL US:
Ultrasound for Week(s) #:


First Trimester Dating OBS US
Detailed 18 week OBS US
Nuchal Translucency OBS US
Antepartum bleeding OBS US

MODALITY:
X-ray Ultrasound Doppler

SIDE:
Left Right Bilateral

BODY PART:
Head Sinuses Carotids Thyroid
Chest Abdomen Pelvis Renal
C-spine T-spine L-spine
Shoulder Shoulder FOI
Humerus Elbow Forearm
Wrist Scaphoid Hand Finger
Hip Hip THA Femur
Knee Knee TKA Knee OA
Lower leg Ankle Foot
Ankle OA Foot OA

REASON FOR EXAMINATION:
pain swollen decreased ROM fall
FOOSH trauma ?fracture ?dislocation
?OA ?DVT
chronic cough ?pneumonia bruit
GERD Change in bowel habits

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