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Lower Extremity Arterial Duplex Final Report - …

Lower Extremity Arterial Duplex Final Report 901 West 43rd St. Telephone: 913-888-8866. Kansas City, MO 64111 Fax: 913-888-8829. Name: SAMPLE PATIENT Date: 00/00/2009 Location: SAMPLE LOCATION. DOB: 05/13/1969 Ht: Wt: 128 Sonographer: Sample, MHS, RDCS. Age: 39 Sex: F Ordering Phys Sample MD, Doctor 999-999-9999. Procedure CPT - 93925 INDICATIONS: Limb pain, Positive ABI. RIGHT ABI: PT: DP: ABI: DP: PT: LEFT. Post Ex Ankle Pressure: Velocity Velocity Post Ex Ankle Pressure: Phasicity Ratio (cm/s) (cm/s) Ratio Phasicity Mono Prox CFA Tri Mono Dst CFA Tri Mono Prox DFA Bi Mono Prox SFA Tri Mono Mid SFA Tri Mono Dst SFA Tri Mono POP Tri Mono TPT Tri Mono Prox AT Bi Mono Prox PER Bi Mono Prox PT Tri Mono Mid PT Tri Mono Dst PT Bi DP Bi Lower Extremity Arterial Duplex Final Report 00/00/2009 2 of 2.

Final Interpretations: Right: Left: LOWER EXTREMITY ARTERIAL DUPLEX FINAL REPORT 2 of 2 Patient Follow Up Recommendations: 1 year, If clinically 020090/00/ Reading Cardiologist MD

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