▲
▼
▲
▼
Wt check >3m ago
cm
kg
▲
▼
eGFR more than 90d old
Stamp
Signature
Subject:
Choose Tickler reminder date
4 weeks
6 weeks
IHA CT Imaging eForm, V4_May20_2022, by Dr. John Yap, is licensed under a
GPL
. Based on FHA Imaging Req by Drs. Page et al.
Please consider supporting
oscarbc.ca
|
info@oscarbc.ca
|
Facebook
|
Twitter
|
LinkedIn
|
Choose a location
Cranbrook
Kamloops
Kelowna
Nelson
Penticton
Salmon Arm
Trail
Vernon
Willams Lake
CAR GUIDELINES
SIDE:
Left
Right
Bilateral
BODY PART:
Head
Sinuses
Carotids
Thyroid
Chest
Abdomen
Pelvis
Renal
C-spine
T-spine
L-spine
Shoulder
Humerus
Elbow
Wrist
Forearm
Scaphoid
Hand
Hip
Femur
Knee
Ankle
Foot
Lower leg
Change contact info as needed
Name:
Office Ph:
Office Fax:
Call if positive
Call result
Fax if positive
Fax
Send to ER if positive
URGENT
EMERGENT