Woodbridge Radiology



ULTRASOUND PATIENT QUESTIONAIREAPPOINTMENT DATE_________________________TIME_______________________Patient’s Name __________________________ DOB_____________ (Circle) Male/FemaleType of Scan ___________________________________R/O_________________Referring Physician ___________________________ Phone #_____________________BODY PARTPREPSABDOMEN (RUQ, LUQ, RLQ, LLQ, GB, LIVER, AORTA)6-8HRS OF FASTING (NOTHING TO EAT OR DRINK). SHOULD BE DONE BEFORE BARIUM WORK UP.PELVIC/ BLADDER(MALE PELVIC SAME PREP)16-32 OZ OF WATER. 1HR BEFORE TEST. NO VOIDING IN BETWEEN.( INCASE PATIENT NEEDS TO USE THE RESTROOM, CAN VOID BUT DRINK AGAIN)TRANSVAGINALNO PREPRENAL ARTERY DOPPLER/ KIDNEYNO PREPTHYROID/ SOFT TISSUE NECKNO PREPVENOUS DOPPLER UPPER EXT LOWER EXTNO PREPARTERIAL DOPPLER UPPER EXT LOWER EXTNO PREPNON VASCULAR EXTREMITYNO PREPTESTICLES/SCROTUMNO PREPCAROTIDNO PREP***** NO OB OR BREAST ULTRASOUND ................
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