carasmall.jpg (10390 bytes)

Nuclear Medicine Request

 

Doctor's Name:   Doctor's E-mail: Doctor's Telephone:

 

Patient's Name: Patient's Age: Patient's Sex: Male  Female
Medical Plan: Clinical Diagnosis:   Pertinent History:  

 

Brain Spect
Brain Scan with Flow
Salivary Glands Scan
Lung-Perfusion
Radioisotope Venogram
Bone Scan
Bone Three Phase
Bone Spect
Bone Marrow Scan
Lymph Nodes Scan
Gallium Scan
Gallium SPECT
Parathyroid Scan
Scintimamograf�a
GASTROINTESTINAL

Milk Scan
Liver - Spleen Scan (Colloid)
Liver - S.P.E.C.T.
Hepatobiliary Scan only (HIDA)
Hepatobiliary Scan with CCK
Gastroesophageal Reflux
Active G.I. Bleeding Scan

CARDIOVASCULAR

Angiocardiography
Shunt Evaluation
Acute Infarct Scan (PYP)
Ventricular Function (M.U.G.A.)
Myocardial Perfusion - Sestamibi Scan
           Rest,        Stress
Persantine
Dobutamina
Adenosina

 

RENAL

Blood Flood
Renal Scan
Mag 3
Glomerular Agent (DTPA)
DMSA
S.P.E.C.T.
Renogram
Diuresis Renogram (Lasix)

 

DENSIOMETRIA OSEA

Spine and Hip
Forearm
Complete Eval.-Flow, Scan Renogram
Complete Eval. with Diuresis (Laxis)
Direct Cystogram
Transplant Evaluation

 

THYROID STUDIES

Thyroid Profile -
           Includes: 24 hours uptake and Scan
24 hours uptake only
Fractional uptake
TSH Stimulation
Suppression Test
I-131 Therapy Thyroid Cancer (per-consultation)
I-131 Whole Body

 

 

 

OTHER (specify)

 

 

 

WE HONOR MEDICARE, SSS, PRIVATE HEALTH PLAN, MCS, etc.
For studies NOT listed PLEAE CALL US.  We encourage consultations.

 

titulo.gif (5058 bytes)

P�gina Principal - Referidos - Gammacamara - Densitómetro - Orientación - Mapa