CAR GUIDELINES




SIDE:
Left Right Bilateral

BODY PART:
Head Sinuses Carotids Thyroid
Chest Abdomen Pelvis Renal
C-spine T-spine L-spine
Shoulder Humerus Elbow Wrist
Forearm Scaphoid Hand
Hip Femur Knee Ankle Foot
Lower leg

Change contact info as needed

Name:  
Office Ph:
Office Fax:

Call if positive
Call result
Fax if positive
Fax
Send to ER if positive

URGENT     EMERGENT