ULTRASOUND REGISTRY REVIEW SIMPLIFIED
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Name:____________________________________________ Date:_____/_____/____ ID:_________________
DOB: _____/______/______ Age:______ Sex: M / F Referring Physician:_________________________
Indications:__________________________________________________________________ Tech:_________
Height: _____________ Weight:______________
RIGHT: PSV/EDV
CCA prox: ____/____ cm/s
CCA dist: ____/____cm/s
ICA prox: ____/____cm/s
ICA dist: ____/____ cm/s
ECA: ____/____cm/s
SUBC: ____/____cm/s
VERT: ____/____cm/s
Antegrade / Retrograde
ICA/CCA ratio: ________
Brachial Pressure:______mmHg
LEFT: PSV/EDV
CCA prox: ____/____ cm/s
CCA dist: ____/____cm/s
ICA prox: ____/____cm/s
ICA dist: ____/____ cm/s
ECA: ____/____cm/s
SUBC: ____/____cm/s
VERT: ____/____cm/s
Antegrade / Retrograde
ICA/CCA ratio: ________
Brachial Pressure:______mmHg
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