Radiology Associates of the Fox Valley Breast Ultrasound Worksheet free printable template
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Patient Name: DOB: Date: BREAST ULTRASOUND WORKSHEET CLINICAL INFORMATION (CIRCLE ALL THAT APPLY): Breast pain, breast lump/mass, nipple discharge, galactorrhea (not associated with birth), nipple
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How to fill out breast ultrasound worksheet
How to fill out Radiology Associates of the Fox Valley Breast Ultrasound Worksheet
01
Begin by entering the patient's personal information at the top of the worksheet including name, date of birth, and contact information.
02
Specify the date of the ultrasound and the referring physician's name.
03
Indicate the reason for the ultrasound, such as breast pain, lumps, or follow-up.
04
Complete the physical examination findings section by noting any relevant observations.
05
Record any pertinent medical history, including previous breast surgeries or family history of breast cancer.
06
Check the appropriate boxes for any prior imaging studies related to the breast, including mammograms or previous ultrasounds.
07
Include any medications currently being taken by the patient.
08
Sign and date the worksheet to certify that all information is accurate.
Who needs Radiology Associates of the Fox Valley Breast Ultrasound Worksheet?
01
Patients who require breast imaging evaluations for symptoms like pain or lumps.
02
Healthcare providers referring patients for breast ultrasounds.
03
Individuals undergoing routine breast cancer screenings.
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What is Radiology Associates of the Fox Valley Breast Ultrasound Worksheet?
The Radiology Associates of the Fox Valley Breast Ultrasound Worksheet is a standardized form used by healthcare providers to document and assess breast ultrasound exams in patients.
Who is required to file Radiology Associates of the Fox Valley Breast Ultrasound Worksheet?
Healthcare practitioners who perform breast ultrasound examinations, including radiologists and sonographers, are required to file the Radiology Associates of the Fox Valley Breast Ultrasound Worksheet.
How to fill out Radiology Associates of the Fox Valley Breast Ultrasound Worksheet?
To fill out the worksheet, practitioners need to enter patient information, details of the ultrasound procedure, findings, and any recommendations. Each section should be completed accurately and thoroughly.
What is the purpose of Radiology Associates of the Fox Valley Breast Ultrasound Worksheet?
The purpose of the worksheet is to ensure comprehensive documentation of breast ultrasound exams, facilitating accurate analysis, diagnosis, and follow-up care for patients.
What information must be reported on Radiology Associates of the Fox Valley Breast Ultrasound Worksheet?
The worksheet must report patient demographics, clinical history, ultrasound findings, impression, and any follow-up recommendations.
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