Transcription of INTERVENTIONAL RADIOLOGY DOB: Date: INVASIVE …
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INTERVENTIONAL RADIOLOGY DOB: Date: INVASIVE …
Name: _____. MRN:_____. INTERVENTIONAL RADIOLOGY DOB:_____ Date: _____. INVASIVE PROCEDURE CONSULT FORM. Procedure date/time:_____. INTERVENTIONAL RADIOLOGY Scheduling Number: (806) 775-8770; Fax Number: (806) 775-8719. INTERVENTIONAL RADIOLOGY INVASIVE PROCEDURE CONSULT FORM. _____. Special Instructions: A minimum 2 hour recovery time for outpatient procedures/NPO after midnight the night before the procedure. Paracentesis/Thoracentesis/Thyroids & Venograms do not require patients to be NPO or recovery time. (All procedures will be reviewed by Radiologist prior to scheduling). Abdominal/Retroperitoneal Mass Biopsy Lymph Node Biopsy: Location:_____. Ablation of _____(Microwave/Cryo) Mediastinal Mass Biopsy Abscess Drain: Location: _____ Neck Mass Biopsy Nephrostomy Tube (Placement/Exchange)(Right or Adrenal Biopsy (Right or Left).)
*Physician Signature_____ Date/Time_____ * Physician signature required Page 1 of 1- Interventional Radiology Consultation Form 02/21/2017 (V-6) Interventional Radiology Scheduling Number: (806) 775-8770; Fax Number: (806) 775-8719
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