Cardiopulmonary Orders 6-07

Cardiopulmonary Orders 6-07 -

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View Full Document Right Arrow Icon Cardiopulmonary Orders ATTENTION PATIENTS: Please remember to bring this form with you to the hospital for your test. Your test may be delayed or cancelled if we do not have this form. Patient Name: Patient Contact Number: Diagnosis: Precert needed: Yes No ICD-9 Code: Precert #: Ordering Physician: Referral needed: Yes No Physician Phone Number: STAT Call Report to: Yes No #: Physician Signature and Date: NPI #: ATTENTION PHYSICIAN OFFICES: Please select tests below. Call Patient to Schedule Cardiac Echo Complete Echo Complete Echo with Bubble Study Stress Echo Dobutamine Echo Trans Esophageal Echo (TEE) Other:___________________________________ Treadmill Exercise Treadmill Nuclear Medicine Nuclear Dual Isotope Stress Test Nuclear Adenosine Nuclear Adenosine Walking Nuclear Dobutamine Nuclear Thallium Viability Study Nuclear MIBI-MIBI Nuclear Persantine Other:___________________________________ EKG EKG Syncope Study Tilt Table Pulmonary Services Studies Baseline Spirometry Spirometry Pre & Post Bronchodilator Complete Pulmonary Function Complete Pulmonary Function with ABG Arterial Blood Gas Other:___________________________________ Neurodiagnostic
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This note was uploaded on 12/26/2009 for the course PHYS 341 taught by Professor Mavromatis during the Spring '09 term at American University of Beirut.

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Cardiopulmonary Orders 6-07 -

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