Scheduling: 972-612-6525 Fax: 469-484-2326
Diagnosis (All test/procedures ordered must have a diagnosis and reason for testing)
Physician's Signature (required for order) To request radiology images or reports contact us at 972-566-7226 3-D Reformation BILATERAL Fluoroscopy Nuclear Medicine Radiology Rapidscreen Chest CAD will be completed on all chest x-rays. We will follow protocols for age and timeliness. BILATERAL
Pregnancy Test Electrocardiogram (Blood Serum) (EKG)
7777 Forest Lane Dallas, Texas 75230 (972) 566-7000
IMAGING ORDER FORM (All test/procedures ordered must have a diagnosis code and reason for testing)
Physician's Signature (required for order) Vascular/Interventional - For these exams contact 972-566-7866 (phone) or 972-566-6290 (fax) Kyphoplasty - For these exams contact 972-566-7866 (phone) or 972-566-6920 (fax) Thoracic Spine (Level ) Lumbar Spine (Level ) Please check all signs and symptoms related to this patient (Kyphoplasty only)
Closed thoracic fx w/o spinal cord injury (additional information needed regarding cause)
Closed lumbar fx w/o spinal cord injury (additional information needed regarding cause)
Compression fx (additional information needed regarding cause)
Pathologic fx (additional information needed regarding cause)
For More Information about Your Procedure visit us at:
Medical City Imaging at Medical City Dallas Hospital 7777 Forest Lane Building D, Suite 200 Dallas, Texas 75230 PARKING: Parking access to Building D is located at the corner of Park Central and Merit Drive. Building D valet parking available from 8:00 a.m. to 5:00 p.m. Visitor Parking is open 24 hours a day at the corner of Forest Lane and Park Central Drive for Buildings A,B, and C. Parking fees are as follows: Up to 1 hour: $1.00 61 minutes - 2 hours: $2.00 Over 4 hours: $4.00 Valet Parking for visitors is available Monday through Friday for $4.00 per day at Building A and C from 8:00 a.m.-6:00 p.m., and at Building D from 8:00 a.m.-5:00 p.m. Parking Meters are also available on Park Central Drive.
7777 Forest Lane Dallas, Texas 75230 (972) 566-7000
IMAGING ORDER FORM
FOR BETTER BORDER BUSINESS A primer designed to help Canadian business people understand the legal and practical basics of crossing the USA border to take advantage of the world’s largest and most responsive market. These tips presented courtesy of: Jim Pettinger , President, International Market Access, Inc., a Ferndale, Washington warehousing, freight management a
CHAPTER 17 Prostate cancer Judd W. Moul, MD, FACS, Kenneth J. Pienta, MD, Brent K. Hollenbeck, MD, and Michael E. Ray, MD, PhD Prostate cancer is the most common cancer in American men. Despite the factthat this cancer will be diagnosed in an estimated 232,090 American men inthe year 2005 and will lead to the death of approximately 30,350 men, there isno universally agreed-upon strategic pla
Scheduling: 972-612-6525 Fax: 469-484-2326
(All test/procedures ordered must have a diagnosis code and reason for testing)
Physician's Signature (required for order)