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Sonographer |
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Exam Performed At |
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Date |
YYYY-MM-DD |
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Patient |
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MRN |
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Visit# |
*Use if scanned on Ultrasonix* |
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Indication |
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Cardiac Activity |
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Effusion |
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Gross Cardiac Function |
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Other Findings |
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Interpretation |
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Confidence in US diagnosis |
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Comments |
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Images Saved? |
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Images Reviewed by: |
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Confirmatory Exam Obtained? |
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Used for Clinical Decision Making? |
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Study Limitations |
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