Patient DOB: Date of Study: Lab:
|
|
|
- Austin Poole
- 5 years ago
- Views:
Transcription
1 Mammogram Count: 1-5 Last Anatomical Study: 2/1/00 Study Results: fine Diagnosed with Cancer: No Date of Diagnosis: - Cancer Type: - Treatment: none Hormone Therapy: none Breast Disorders: breast reduction in 1987 Surgical History: 4x-tubes tonsils/adenoids 4x larposcopy breast reduction 1987 parathyroid 2009 gallbladder-2001 c section 2004 pt hysterectomy ovary removal 2007 Patient Name: lissa bertsch Patient DOB: Date of Study: Lab: March June Cincinnati Ohio Pain Lump Cancer Concerns: in my left breast there has been pain and soreness however I have severe fibromyalgia fibroid cysts in my breasts and Im having severe neck and left shoulder to shoulder blade pain with muscle tightening and severe pulling and pain. My muscle is all bunched together with Charlie horse constant pain. I also get quite a few boils and cysts. I have since the age of 18. I also had a breast reduction in 1987 Breast Symptoms: Hysterectomy Miscellaneous Symptoms: Head allergies Headaches Thyroid Sinus problems Neck pain Head Concerns: my discs in my neck my pain and inflammation in my left shoulder left shoulder blade my bunched muscle on top of my shoulder Acid reflux Abs History: all surgeries previous page Abs Concern: on Thursday may 11 I will be receiving 6 epidural injections for neck and shoulder pain dr will try TRIGGER POINT injections if my knots are down Left shoulder Left elbow Left arm Upper History: surgeries on prior page Upper Concerns: pain travels down left arm shoulder elbow cannot put pressure on arm cant hold a lot of weight there is numbness and tingling from time to time Lower Concerns: none Exam Notes: Piercings don't come out. Goes for chiro and massage. Drinks ACV everyday. Fibromyalgia since 13 years old. Vascular Patterns Focal Hyperthermia Right Breast Asymmetrical: unilateral area of vascular patterns A questionable pattern of vascularity is seen. This creates a need for future monitoring as recommended ºC Small area of focal hyperthermia seen Left Breast Asymmetrical: unilateral area of vascular patterns A questionable pattern of vascularity is seen. This creates a need for future monitoring as recommended No significant area of focal hyperthermia noted Global Global hyperthermia is seen (>0.3C) -.82ºC Global hyperthermia is seen (>0.3C) Nipple/Areola Contour Delta t temperature measurements above normal limits (>1.0C) ºC A normal contour is seen in inverse grayscale imaging Delta t temperature measurements above normal limits (>1.0C) - ºC A normal contour is seen in inverse grayscale imaging
2 Fibrocystic Assessment Comparative Study General Impressions Recommendations Follow-up Previous Score: NA Current Score: 4 No Change None The right breast shows a higher thermal activity demonstrated by a global delta t of 0.82ºc which is significantly higher than the threshold also some areas of focal hyperthermia with deltas as high as 4.19ºc are present including right nipple hyperthermia along with questionable patterns of vascularity creating the need for anatomical testing and thermal follow up in 6 months to establish a baseline. The moderate mottling patterns noted across the breasts bilaterally may indicate fibrocystic changes. Consultation with an integrative doctor is recommended in order to assess hormone levels eliminate toxins that may be producing these abnormal heat patterns and improve overall lifestyle. Anatomical testing (mammogram MRI or ultrasound is recommended Lifestlye changes 6 months Patient Symptoms Head allergies Headaches Thyroid Sinus problems Neck pain Head Concerns: my discs in my neck my pain and inflammation in my left shoulder left shoulder blade my bunched muscle on top of my shoulder Acid reflux Abs History: all surgeries previous page Abs Concern: on Thursday may 11 I will be receiving 6 epidural injections for neck and shoulder pain dr will try TRIGGER POINT injections if my knots are down Left shoulder Left elbow Left arm Upper History: surgeries on prior page Upper Concerns: pain travels down left arm shoulder elbow cannot put pressure on arm cant hold a lot of weight there is numbness and tingling from time to time Lower Concerns: none Head/Neck Symptoms: Head Allergies Headaches Sinus Problems Neck Pain Concerns: my discs in my neck my pain and inflammation in my left shoulder left shoulder blade my bunched muscle on top of my shoulder Thermal Impressions: Oral inflammation Nasal hyperthermia Cerebrovascular Screening Temp: 0.10 Cerebrovascular Screening: Normal Oral Inflammatory Factor: 9 Anterior neck congestion Lymphatic congestion disguising possible thyroid condition Comments: The cerebrovascular screening shows a supraorbital delta T within normal range. Severe nasal and oral inflammation and lymphatic congestion that extends to the submandibular and anterior cervical regions and may be disguising a possible thyroid condition clinically correlate. Recommendations: Clinical correlation Dental consultation Chest Not Performed Abdomen Symptoms: Acid Reflux Surgical History: all surgeries previous page Concerns: on Thursday may 11 I will be receiving 6 epidural injections for neck and shoulder pain dr will try TRIGGER POINT injections if my knots are down Thermal Impressions: Hyperthermic URQ Hyperthermic ULQ Comments: The bilateral upper abdominal quadrant hyperthermia may indicate liver gallbladder colon and/or stomach irritation clinically correlate. Recommendations: Clinical correlation Spine/Posture Symptoms: - Thermal Impressions: Interscapular hyperthermia Thoracic hyperthermia Lumbosacral hyperthermia Postural deviation Comments: There are areas of hyperthermia on the upper and lower back that may indicate an underlying spinal segmental dysfunction clinical evaluation and chiropractic consultation are advised. Recommendations: Clinical correlation Chiropractic evaluation Lower Extremity Not Performed Upper Extremity Not Performed General Impressions No remarks. Follow-up 1 year A Note to the Physician
3 Relevant comments are made to direct the physician in clinical management. This important tool should be used in addition to the physician's other diagnostic tools to create a complete clinical impression. The areas highlighted represent areas of concern that may need to be investigated by clinical correlation and other testing. This may include physical exam palpation radiology metabolic testing or other traditional methods of diagnosing. Thermographic imaging is a screening test that alerts of possible areas of pathology at the indicated levels. Normal variants are also common. Sometimes pathological findings appear earlier than tradition tests. Close thermal follow-up is highly recommended over time. *Thermographic Wellness Inc is a PACT certified interpretation service that has contracted the above interpreters for this evaluation. Interpreted and reviewed by Thermographic Wellness Inc based on the standards of the Professional Academy of Clinical Thermology. DESCRIPTION OF THE CLINICAL THERMAL IMAGING STUDY The patient above was examined by digital infrared thermal imaging using a high-resolution thermographic camera specific for clinical applications. Standardized thermography protocols were observed which are designed to optimize clinical correlation of thermal patterns. Medical Thermography is a system using a highly technical and non-contact infrared camera to capture and record temperature variations on the skin the largest organ of the body. As such the surface of the skin provides vital information that is directly influenced by complex metabolic and vascular activity including micro-circulation below the surface via the sympathetic nervous system. These patterns of activity vary in intensity and distribution over each body region represented by images with variation in colors. Detection of variations in skin temperature allows for recognition of asymmetric abnormal or suspicious thermal patterns over a specific area or region of interest. Changes of these patterns may be recognized by the interpreter as abnormal physiology or function. Thermal Analysis This report is based on study guidelines that are based on but not limited to side-to-side temperature intensity measurement and comparison established thermological signs including pattern recognition and comparison of changes over time. This method of analysis allows objective clinical correlation by the patient's physician and contributes to the decision-making process regarding therapy additional testing and eventual diagnosis. Breast Thermography Thermography is defined by the Food and Drug Administration (FDA Code of Federal Regulations Sec ). Thermography is an adjunctive test and does not replace mammography or any other anatomical imaging test. A negative thermogram mammogram or ultrasound does not preclude biopsy based on clinical condition. The value of thermography as a screening tool is the non-invasive nature of the test and the unique ability to accurately measure skin temperature changes. Such monitoring affords detection of even subtle thermal changes that although not independently diagnostic may precede anatomical findings by years and prompt early investigation and prevention. As there is no single known test capable of monitoring all complex anatomical and biological influences of disease monitoring with additional testing such as ultrasound MRI mammography or other testing as recommended by the patient's personal physician is always advised. Study Outcome This study provides adjunctive clinical information and recommendations based solely upon the images and patient information provided to support the patient's physician in medical or health evaluation. All findings in this report are considered by the interpreter to be related to the general health of the reported region. A "Thermographically Suspicious" finding in this report does not indicate that it is suspicious for any specific disease. This report has been analyzed by the following interpreters according to PACT Standards and Protocols: Prepared by: Beth Borchers DC Preliminary Interpreter: Peter Lang MD FPACT Senior Interpreter: Alexander Sepper MD PHD
4 LissaBertsch_15 LissaBertsch_15 LissaBertsch_15 LissaBertsch_15 Image Zone Min Delta T(Min) Max Delta T(Max) Avg Delta T(Avg) Left ºC ºC ºC 1.24 Left ºC ºC ºC Left ºC ºC ºC 4.19 Left ºC ºC ºC Left ºC ºC ºC 1.81 Left ºC ºC ºC Left ºC ºC ºC 0.82 Left ºC ºC ºC 1/9
5 LissaBertsch_20 LissaBertsch_19 Image Zone Min Delta T(Min) Max Delta T(Max) Avg Delta T(Avg) Left ºC ºC ºC 3.02 Right ºC ºC ºC LissaBertsch_20 LissaBertsch_19 2/9
6 LissaBertsch_16 LissaBertsch_17 LissaBertsch_16 LissaBertsch_17 LissaBertsch_18 LissaBertsch_18 3/9
7 LissaBertsch_21 LissaBertsch_21 LissaBertsch_9 LissaBertsch_9 Image Zone Min Delta T(Min) Max Delta T(Max) Avg Delta T(Avg) Left ºC ºC ºC 0.10 Left ºC ºC ºC 4/9
8 LissaBertsch_10 LissaBertsch_11 LissaBertsch_10 LissaBertsch_11 LissaBertsch_12 LissaBertsch_12 5/9
9 LissaBertsch_13 LissaBertsch_14 LissaBertsch_13 LissaBertsch_14 LissaBertsch_7 LissaBertsch_7 6/9
10 LissaBertsch_8 LissaBertsch_5 LissaBertsch_8 LissaBertsch_5 LissaBertsch_6 LissaBertsch_6 7/9
11 LissaBertsch_4 LissaBertsch_1 LissaBertsch_4 LissaBertsch_1 LissaBertsch_3 LissaBertsch_2 8/9
12 LissaBertsch_3 LissaBertsch_2 9/9
Patient DOB: Date of Study: Lab:
Patient Name: Sarah McClennen Patient DOB: Date of Study: Lab: August 2, 1965 June 26, 2017 Concord, New Hampshire Pain Lump Cancer Mammogram Count: 5-10 Last Anatomical Study: 6/5/13 Study Results: normal
THERMAL BREAST IMAGING REPORT
THERMAL BREAST IMAGING REPORT Patient: Sample Patient DoB: 01/01/1975 Date of Scan: 02/13/2018 Technician: Technician, CTT Date of Report: 02/22/2018 Imaging Center: Thermal Imaging Center Dear Ms. Patient,
Clinical Applications of Medical Thermography
Clinical Applications of Medical Thermography Alexander Mostovoy, HD, DHMS, BCCT Thermography Clinic Inc. ABSTRACT Infrared thermography as a medical screening tool is gaining popularity and acceptance
&tocpath=userl /23/2013
Report Page 1 of3 Electronic Medical InterpreLaCion REPORT EMI Inc. 2030 W. First St., Suite E Fort Myers, Florida 33901 admin@emiinterp.com Patient: John Anderson Date of Birtli: 09/23/1967 Patient ID:
Medical Thermal Imaging Consent
Medical Thermal Imaging Consent Patient s Name: Age: Date: Address: City: State: Zip: Home Phone: Cell Phone: E-Mail: Referred By: Check here to have your report and history forms sent to your doctor at
Medical Thermal Imaging Consent
Medical Thermal Imaging Consent Patient s Name: Age: Date: Address: City: State: Zip: Home Phone: Cell Phone: E-Mail: Referred By: Check here to have your report and history forms sent to your doctor at
Thermal Imaging Instructions
Thermal Imaging Instructions Name DOB Body Temperature Room Temperature Technician Welcome to Midwest Thermography. Before you arrive for your thermographic examination, certain protocols must be followed
Medical Thermal Imaging Consent
Medical Thermal Imaging Consent Patient s Name: Age: Date: Address: City: State: Zip: Home Phone: Cell Phone: E-Mail: Referred By: Check here to have your report and history forms sent to your doctor at
Medical Thermal Imaging Consent
Medical Thermal Imaging Consent Patient s Name: Age: Date: Address: City: State: Zip: Home Phone: Cell Phone: E-Mail: Referred By: Check here to have your report and history forms sent to your doctor at
THERMOGRAPHY PREPARATION INSTRCUTIONS. Lotus Path Wellness Center 3642 Madaca Lane Tampa, FL
THERMOGRAPHY PREPARATION INSTRCUTIONS Lotus Path Wellness Center 3642 Madaca Lane Tampa, FL 33618 813.964.0847 Thank you for choosing Lotus Path Wellness Center as your source for thermal imaging. We look
Breast Thermography- A Responsible Second Look
Breast Thermography- A Responsible Second Look William Cockburn, D.C., D.A.B.F.E., F.I.A.C.T Breast cancer and other breast diseases have become a tremendous issue in women's health today, particularly
Serving the Holistic Medical Community...
Kristin M. Burton, CNHP, CCT Owner/President/CEO of Serving the Holistic Medical Community... With cutting-edge Ultra High Definition Infrared Imaging providing the earliest look at the most important
Contemporary Evaluation of Thermal Breast Screening. Background. Anthony Piana, DC. Alexander Sepper, MD, PhD
Contemporary Evaluation of Thermal Breast Screening Anthony Piana, DC Alexander Sepper, MD, PhD Background Breast cancer is one of the major problems of modern oncology, and has certainly received the
Breast Thermography A radiation-free breast health assessment suitable for young women By Janet van Dam Medical Thermographer/ Member ACCT
Breast Thermography A radiation-free breast health assessment suitable for young women By Janet van Dam Medical Thermographer/ Member ACCT I often get the question: at what age should I start worrying
REPORT. AH normal protocols were observed HISTORY AND SUBJECTIVE COMPLAINTS:
Report Page 1 of3..^ E'ectrontc Bee Medical int.erpre-.a>;ior REPORT EMI Inc. 2030 W. First St., Suite E Fort Myers, Florida 33901 admin@iemiinterp.com Patient: John Anderson Date of Birth: 09/23/1967
Thermal Imaging Instructions
Thermal Imaging Instructions Name DOB Body Temperature Room Temperature Technician Welcome to Midwest Thermography. Before you arrive for your thermographic examination, certain protocols must be followed
Contributors. Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images:
Contributors Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images: Peter Miller, MD, Indiana University School of Medicine Chapter 1: Figure
Mammograms Vs. Thermograms
Mammograms Vs. Thermograms October is Breast Health Awareness month. Let s change the words from cancer to HEALTH and start thinking what we can do to be proactive in prevention. We have awareness about
Purpose. Assists in interpretation of clinical data Important t to outcomes measurement Important to new knowledge
Clinical Correlation of Thermographic Findings using Client History Clinical History Taking Purpose Defines disease risk Assists in interpretation of clinical data Important t to outcomes measurement Important
Pain Management. Medicine. without limits
Pain Management Medicine without limits Minimally invasive therapies for chronic pain relief Thanks to advances in medicine, you don t have to live with the debilitating effects of chronic pain. The physicians
COMENIUS-Project: SM&CLIL Radiation & Medicine
Medical imaging refers to the techniques and processes used to create images of the human body (or parts thereof) for clinical purposes. Thanks to modern mathematics and computer technology, medical imaging
Thermography in Breast Cancer Detection (Published in Price-Pottenger Nutritional Foundation Newsletter, 2010)
Thermography in Breast Cancer Detection (Published in Price-Pottenger Nutritional Foundation Newsletter, 2010) Seminar Presented by: George E. Chapman, DC, CCSP, DABCT Victoria Lea, MLS, HHP, CTT Thermography
CRT2000 Thermographic System
CRT2000 Thermographic System Contact Regulation Thermography Measurement Procedure & Interpretation of Results CRT system Consists of a temperature probe & a computer for data display & analysis Measures
SUMMARY OF FINDINGS OF DIGITAL INFRARED THERMAL IMAGING CLINICAL TRIALS WITH INBALANCE TECHNOLOGY TREATED MATERIALS
SUMMARY OF FINDINGS OF DIGITAL INFRARED THERMAL IMAGING CLINICAL TRIALS WITH INBALANCE TECHNOLOGY TREATED MATERIALS Robert A. Erickson, M.D., F.A.A.F.P - June 2012 Introduction In January 2012 InBalance
CPT CODES. Ph: (307) Fax: (307) CATSCAN IV Contrast: 87.00
Ph: (307) 382-4282 Fax: (307) 382-4291 CPT CODES CATSCAN IV Contrast: 87.00 74150 Abdomen w/o contrast $ 809.00 74160 Abdomen w/ contrast $1175.00 w/ contrast: $1262.00 74170 Abdomen w_w/o contrast $1324.00
Client Name: Date: Birthdate: Age: Gender: F M Address: Phone # home: cell: work:
7606 N. Union Blvd. Ste. A Colorado Springs, Colorado 80920 phone: 719-573-2254 New Client Female History Client Name: Date: Birthdate: Age: Gender: F M Address: Email: Phone # home: cell: work: Thermogram
RAINIER VALLEY CHIROPRACTIC P.S th Avenue S. Seattle, WA 98118
Patient Health History Full Name Date Street Address City & State Zip Phone Number Gender Date of Birth Age SSN How did you hear about our office? Marital Status # of Children? Currently Pregnant? / How
Breast Cancer. Common kinds of breast cancer are
Breast Cancer A breast is made up of three main parts: glands, ducts, and connective tissue. The glands produce milk. The ducts are passages that carry milk to the nipple. The connective tissue (which
ABSTRACT. Testing the effects of the 8ight Relief Holographic Disc on pain areas using Thermal Imaging
ABSTRACT Testing the effects of the 8ight Relief Holographic Disc on pain areas using Thermal Imaging Investigators: HealthWalk thermal imaging specialist trained by Duke University Test Subjects: Testing
Detecting and Treating Breast Problems
WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Detecting and Treating Breast Problems A woman's breasts are always changing. They change during the menstrual cycle, pregnancy, breastfeeding,
Certification Review. Module 28. Medical Coding. Radiology
Module 28 is the study of x-rays, using radiant energy and other imaging techniques, such as resonance imaging or ultrasound, to diagnose illnesses and diseases. Vocabulary Barium enema (BE): lower gastrointestinal
Intake Questionnaire ADVANCED IMAGING
Please answer all questions below and notify the technologist of any metal inside or on your body. For MRI s, please remove all removable metal from your body such as hearing aides, hairpins, jewelry,
By progressive monitoring of an infection site, the regression and resolution of an active infection can be non-invasively monitored.
Anterior Knees Medial Right knee Lateral Right knee Right knee surgery was followed with a painful effusion in the early post operative period. Thermography confirmed a significant inflammatory reaction.
Breast Cancer in Women
The Crawford Clinic 1900 Leighton Avenue Suite 101 Anniston, Alabama 36207 Phone: 256-240-7272 Fax: 256-240-7242 Breast Cancer in Women What is breast cancer? When abnormal cells grow uncontrollably, they
Tapeworm Infection. Tapeworm
Tapeworm Infection Introduction Tapeworm infection is caused by ingesting food or water that is contaminated with tapeworm eggs or larvae. Larvae are newly hatched tapeworms. A tapeworm may attach itself
FY16 BCCS Reimbursement Rates and Billing Guidelines Appendix B 2
FY16 BCCS Reimbursement Rates and Billing Guidelines Appendix B 2 77053 Mammary ductogram or galactogram, single duct, Global Fee $59.05 May be billed with 77055, G0206, 77056, G0204, 76641, 76642 Billable
What is Digital Thermography?
Hello to everyone, Just to inform you that I am booking appointments for thermography screening. It will be held Saturday June 16th at my clinic in Caledon. www.remediesforhealth.ca for directions for
Breast Evaluation & Management Guidelines
Breast Evaluation & Management Guidelines Pamela L. Kurtzhals, M.D. F.A.C.S. Head, Dept. of General Surgery Scripps Clinic, La Jolla Objective Review screening & diagnostic guidelines Focused patient complaints
THERMOGRAPHY CLINIC 1596 REGENT ST. SUDBURY, ON P3E 3Z6
THERMOGRAPHY CLINIC 1596 REGENT ST. SUDBURY, ON P3E 3Z6 HEALTH HISTORY Name: Age: Date of Birth: Address: City: Postal Code Home Tel: Work Tel: E-mail Occupation: Marital Status: S M D W SEP. Number of
BREAST DENSITY WHAT IS IT? WHY IS IT IMPORTANT? & What IOWA SF250 Means to Patients and Providers
BREAST DENSITY WHAT IS IT? WHY IS IT IMPORTANT? & What IOWA SF250 Means to Patients and Providers Arnold Honick, MD Radiology Consultants of Iowa, PLC ahonick@rciowa.com BREAST DENSITY LEGISLATION Nancy
Multi-Diagnostic Services, Inc.
Multi-Diagnostic Services, Inc. 139-16 91st Avenue Jamaica, New York 11435 718 454-8556 Fax: 718 454-7950 Name: Date of Appointment: AM Time: PM What to Expect and How to Prepare for the Mammography Screening
Beyond Mammography. Overview. By: Len Saputo, MD
Beyond Mammography By: Len Saputo, MD Overview The most devastating loss of life from breast cancer occurs between the ages of 30 to 50. Fortunately, women today have more options available to them to
ADULT HISTORY CURRENT STATUS 1.! 3. 2.! 4.
If you have any recent Radiologic Studies or Blood Work please bring it with you. ADULT HISTORY Name:!!! Date: D.O.B:!!! Age:!!!! M F CURRENT STATUS PRIMARY PROBLEMS: 1.! 3. 2.! 4. SYMPTOM DRAWING Please
Beyond Mammography OVERVIEW. Len Saputo, MD
DECEMBER 2003 HEALTH MEDICINE INSTITUTE Beyond Mammography Len Saputo, MD OVERVIEW The most devastating loss of life from breast cancer occurs between the ages of 30 to 50. Fortunately, women today have
CERVICAL SPINE TIPS A
CERVICAL SPINE TIPS A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide Rick Bernau & Ian Wallbridge June 2010 THE PROCESS An interactive approach to the management of
ICD-10 Common Codes per CMS
Abdominal Pain (ICD09-CM 789.00 TO 789.09 range) R10.0 Acute abdomen R10.10 Upper abdominal pain, unspecified R10.11 Right upper quadrant pain R10.12 Left upper quadrant pain R10.13 Epigastric pain R10.2
St. Joseph Hospital MRI Spine Survey/ Total Spine Questionnaire
Spine Survey/ Total Spine Questionnaire P,\Ti[]r f I.'\BIL Circle the appropriate response(s) Do you have? PAIN: NUMBNESS: TINGLING: WEAKNESS: How long have you had these symptoms? Please shade in area(s)
DETERMINATION OF MEAN TEMPERATURES OF NORMAL WHOLE BREAST AND BREAST QUADRANTS BY INFRARED IMAGING AND IMAGE ANALYSIS
DETERMINATION OF MEAN TEMPERATURES OF NORMAL WHOLE BREAST AND BREAST QUADRANTS BY INFRARED IMAGING AND IMAGE ANALYSIS J.F. Head 1, C.A. Lipari 2, R.L. Elliott 1 1 Mastology Research Institute, Baton Rouge,
What muscles are connected to the chest from neck
What muscles are connected to the chest from neck The Borg System is 100 % What muscles are connected to the chest from neck Dec 10, 2016. This article explains how the scalene muscles are involved in
STRETCHING EXERCISES FOR PAIN REDUCTION
PHYSICAL THERAPY RESOURCES STRETCHING EXERCISES FOR PAIN REDUCTION This material is presented for informational and educational purposes only. If you experience any pain or difficulty with these exercises,
Department of Health and Human Services Food and Drug Administration 5600 Fishers Lane, (HFI-40) Rockville, MD March 2000 (FDA)
Department of Health and Human Services Food and Drug Administration 5600 Fishers Lane, (HFI-40) Rockville, MD 20857 March 2000 (FDA)00-4269 What Is A Mammogram? A mammogram is a special kind of x-ray
Who may we thank for referring you? Office Only LIST YOUR HEALTH CONCERNS BELOW. If you had the condition before, when? When did this episode start?
Name Date / / Age Male / Female Address City State Zip Phone: Home Cell Cell Phone Provider Date of Birth / / Email Address Occupation Employer s Name Single / Married / Divorced / Widowed Spouse s Name
Stereotactic Breast Biopsy
Scan for mobile link. Stereotactic Breast Biopsy Stereotactic breast biopsy uses mammography a specific type of breast imaging that uses low-dose x-rays to help locate a breast abnormality and remove a
ADI Procedure Codes. August 2016 Revised April 2017 Page 1 of 7 ADI Procedure Codes
Code Description 70450 CT Head without contrast 70460 CT Head with contrast 70470 CT Head with & without contrast 70480 CT Orbit, et al without contrast 70481 CT Orbit, et al with contrast 70482 CT Orbit,
LIST YOUR HEALTH CONCERNS BELOW
LOCATION COMING SOON Lakewood Ranch, FL 32402 941.877.1507 Name Date / / Age Male/Female Address City State Zip Phone: Home Cell Cell Phone Provider Email Date of Birth / / Employer s Name Position Single
No. 2 - Persistent Pain or Discomfort in Any Body Area
See Your Doctor When Symptoms Occur, and Get Regular Checkups. Experts say that men could benefit greatly by being alert to certain cancer symptoms that indicate a trip to the doctor's office sooner rather
Screening Mammograms: Questions and Answers
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Screening Mammograms:
Patient Information: Screening with Digital Infrared Thermal Imaging
550 Latona Rd., Ste 402 Rochester, NY 14626 Phone: 585-734-6083 E-mail: info@nydti.com Web: www.nydti.com Patient Information: Screening with Digital Infrared Thermal Imaging Purpose of test: Help in determining
On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the areas below:
Healthcare History djp Pure-Health wellness centre www.pure-health.com Wellness Profile General Health On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the
LIST YOUR HEALTH CONCERNS BELOW
8209 Natures Way Unit 115 Lakewood Ranch, Florida 34202 (941) 877.1507 Name Date / / Age Male Female Address City State Zip Phone: Home Cell Cell Phone Provider Email Date of Birth / / Employer s Name
Diagnostic Dilemmas of Breast Imaging
Diagnostic Dilemmas of Breast Imaging Common Causes of Error in Breast Cancer Detection By: Jason Cord, M.D. Mammography: Initial Imaging The standard for detection of breast cancer Screening mammography
New Patient Packet. Patient Name: DOB: Age: Address: City: State: Zip: Address: City: State: Zip: Name: Address: Phone: Fax:
New Patient Packet Patient Name: DOB: Age: Sex: Male / Female Height: Weight: PHYSICIAN CARE Primary Care Physician: Address: City: State: Zip: Phone: Fax: Referring Physician (if different from PCP):
Clinical Anatomy, Embryology and Imaging BMS 6115C. Summer Semester 2009 Lynn J. Romrell, Ph.D. Course Director. Course Schedule
Anatomy, Embryology and Imaging BMS 6115C Summer Semester 2009 Lynn J. Romrell, Ph.D. Course Director Course Schedule Color codes for course activities: Anatomy Sessions Anatomic Radiology Sessions Embryology
Date: SSN: Birthday: First Name: Middle Name: Last Name: Sex: Male Female Height: Weight: Married/Single: Spouse Name: Home # Cell # Work #
Patient Information: Date: SSN: Birthday: First Name: Middle Name: Last Name: Sex: Male Female Height: Weight: Married/Single: Spouse Name: Email: Home # Cell # Work # Text Appointment Reminders: Yes No
Mammography and Other Screening Tests. for Breast Problems
301.681.3400 OBGYNCWC.COM Mammography and Other Screening Tests What is a screening test? for Breast Problems A screening test is used to find diseases, such as cancer, in people who do not have signs
New Patient Questionnaire. Name DOB Date
Medical History (This refers to medical problems that have already been diagnosed or treated. Please explain how this is treated, such as diet, medication, surgery, etc.) Condition Abnormal Pap smear Alcohol
The Harvard Women s Health Watch is committed to helping women un cover helpful
The Harvard Women s Health Watch is committed to helping women un cover helpful information for staying healthy. This report discusses some of the latest breakthroughs in women s health. You ll read about
Thermography in Breast Cancer Detection
Breast Thermography Presented by: George E. Chapman, DC, CCSP, DABCT, DIACT, DICACT, DNBC#, FIACA, FIACT Victoria Lea, MLS, CBPM, HHP, CTT Thermography in Breast Cancer Detection Thermography is exceptional
Breast Cancer Diagnosis, Treatment and Follow-up
Breast Cancer Diagnosis, Treatment and Follow-up What is breast cancer? Each of the body s organs, including the breast, is made up of many types of cells. Normally, healthy cells grow and divide to produce
Cervical Epidural Injection
Cervical Epidural Injection The Cervical Vertebrae The cervical vertebrae are the bones that support your neck and head. They form the top part of your spine. The tunnel made by these vertebrae is called
THE NEW ZEALAND MEDICAL JOURNAL
THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association Breast thermography review The terms of reference for the thermography review (Fitzgerald and Berentson-Shaw. Thermography
Guidelines for Breast Thermography. General Statement:
Guidelines for Breast Thermography General Statement: This guideline was prepared by members of the American Academy of Thermology (AAT) as a guide to aid the breast thermologist, and other interested
SURGICAL BREAST PRACTICE NEW PATIENT QUESTIONNAIRE
Patient Name MRN DATE: SURGICAL BREAST PRACTICE NEW PATIENT QUESTIONNAIRE Date of birth Age REASON FOR VISIT Abnormal Mammogram R L please specify Lump/Thickening R L upper lower inner outer Pain R L upper
Personal Data. Present Symptoms
Chris A. Pate, MD 2280 Hwy 70 West, Suite B 265 Racine Drive, Suite 102 Goldsboro, NC 27530 Wilmington, NC 28403 (919) 988-9332 Fx(919) 581-0353 (910) 399-6661 Fx(910) 399-6667 Name Personal Data Address
Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI P (734) F (734) New Patient Intake Form
Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI 48103 P (734) 547-3990 F (734) 547-3890 New Patient Intake Form Personal Information Name Age Sex Female Male Gender Identify
Medical Affairs Policy
Medical Affairs Policy Service: Back Pain Procedures-Epidural Injection (Caudal Epidural, Selective Nerve Root Block, Interlaminar, Transforaminal, Translaminar Epidural Injection) PUM 250-0015-1706 Medical
The Human Body. Lesson Goal. Lesson Objectives 9/10/2012. Provide a brief overview of body systems, anatomy, physiology, and topographic anatomy
The Human Body Lesson Goal Provide a brief overview of body systems, anatomy, physiology, and topographic anatomy Medial Lateral Proximal Distal Superior Inferior Anterior Lesson Objectives Explain the
Disclaimer no conflict of interest
Disclaimer no conflict of interest Benign Breast Disease Alison Hayes FRACS Content Clinical assessment of the breast Triple assessment Focal nodularity Breast pain Cysts Infection Nipple discharge Gynaecomastia
Sutter Health Plus Effective for Calendar Year 2015
Sutter Health Plus Effective for Calendar Year 2015 CPTs CPT Descriptions 2015 Cost Under Deducible (Single Unit) Doctor's Office Visit for a New Patient (Also Urgent Care) 99201 Low Level Visit $99.00
For Office Use Only: MA complete Date of Visit / / mm/dd/yyyy. This form must be scanned into the medical record. Do not remove from clinic.
For Office Use Only: MA complete Date of Visit / / mm/dd/yyyy This form must be scanned into the medical record. Do not remove from clinic. UWMC Women s Health Care Center & SCCA Women s Cancer Center
2017 Patient Pricelist
2017 Patient Pricelist Attached are the most frequent charges at St. Elizabeth Healthcare. All patients are charged the same irrespective of one s ability to pay. The patient s responsibility may vary
A Patient s Guide to Fibromyalgia
A Patient s Guide to Fibromyalgia 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com DISCLAIMER: The information in this booklet is compiled from a variety of
California Chiropractic Boshears, Inc Yucaipa Blvd., Yucaipa Ca Phone: (909) Fax : (909)
California Chiropractic Boshears, Inc. 35191 Yucaipa Blvd., Yucaipa Ca. 92399 Phone: (909) 790-5005 Fax : (909) 790-5009 Patient Information Date: Name: Address: Home Phone: Work Phone: Sex: Male or Female
Breast Imaging & You
Breast Imaging & You What s Inside: Breast Imaging... 2 Digital Breast Tomosynthesis (DBT) mammograms... 4 Breast cancer screening... 6 Dense breast tissue... 8 Automated Breast Ultrasound (ABUS)... 9
Nutrition Questionnaire
Nutrition Questionnaire This office deals with the health, vitality and longevity of the individual. The following questions will help us to more accurately design a personalized program to allow you to
Re-Exam Questionnaire
Re-Exam Questionnaire Patient Name: Date: The following hi-lighted symptoms are what brought you into our office originally. DIRECTIONS: Please rate ALL hi-lighted symptoms: S = same; B = better; W = worse
Johanna M. Hoeller, DC PS
ENTRANCE FORM Birth date: Height: Weight: Emergency Contact: Emergency Contact Phone: ( ) Spouse/Partner or Parent s name: Children s names: Occupation (Your): Employer: Address: City/State/Zip: Phone:
The spine is made of a column of bones. Each bone, or vertebra, is formed by a round block of bone, called a vertebral body. A bony ring attaches to the back of the vertebral body. When the vertebra bones
intake form About You : General Health Information: Page 1`of 5 State/Province: Country: Zip/Postal Code: Address:
intake form Page 1`of 5 About You : Name: Sex: Male Female Address: City: State/Province: Country: Zip/Postal Code: Home Phone Number: Mobile Phone Number: Email Address: Birthday: Marital Status: Married
Essential #7: Adopt Very Early Detection. Breast Cancer Conqueror 2016
Essential #7: Adopt Very Early Detection Let s face it. In America today we don t have a health care system, we have a sick care system. U.S. Senator Tom Harkins Pink Frenzy Breast Cancer Awareness Month
Syncope and Seizure Questionnaire
Syncope and Seizure Questionnaire World College of Neurology 2/79 Wheatley Drive Bull Creek WA 6149 T 08 93320488 F 08 93329988 Copyright 2011. All rights reserved. Patient Name: MAIN PROBLEM I am here
clear evidence of the signs and symptoms of infection, simply a breast cancer that looks like infection.
Hello, and welcome to The University of Texas MD Anderson Cancer Center lecture series on Inflammatory Breast Cancer. In this section we ll discuss the clinical diagnosis of IBC. My name is Wendy Woodward
Patient History Form
Patient History Form Advanced Directive Care Plan? Yes No Name: Birth date: / / Address: Age: Sex: F M STREET DAY YEAR Telephone: Home ( ) CITY STATE DAY YEAR MARITAL STATUS: Divorced Separated Alive/Age
Anatomy and Physiology Unit 1 Review Sheet
Anatomy and Physiology Unit 1 Review Sheet Chapter 1 Name Date Hour 1. investigates the body's structure, whereas investigates the processes or functions of living things. A. Physiology, cytology B. Physiology,
Breast and Ovarian Cancer
Patient Education Breast and Ovarian Cancer Screening and detection The goal of screening for cancer is to find it as early as possible, when it is easiest to cure. This handout describes the symptoms
Upper back pain that radiates down arm
Upper back pain that radiates down arm Deep upper back pain particularly if it is associated with tingling in arms and hands is often an irritated nerve and not primarily a muscular condition. Explanation
Armed Forces Institute of Pathology.
Armed Forces Institute of Pathology www.radpath.com Armed Forces Institute of Pathology Breast Disease www.radpath.org Armed Forces Institute of Pathology Interpretation of Breast MRI Leonard M. Glassman
Kimberley A. Schroeder, D.O. 115 Baker Drive Tomball, TX
Kimberley A. Schroeder, D.O. 115 Baker Drive Tomball, TX 77375 281.290.0531 www.feelwellagain.com FEMALE MEDICAL QUESTIONNAIRE (POSTMENOPAUSAL) NAME: DATE OF BIRTH: CHIEF COMPLAINT What is your primary
Personal Health History
Personal Health History Last Name First Female ( ) Birth Date Age MI Male ( ) Address Apt# City State Zip PATIENT INFORMATION Home Phone Cell Phone Work Number E-Mail Marital Status Height Weight Goal
CHIROPRACTIC -HOW IT AFFECTS YOU. Dr Milan Hari M- CHIRO. S.A GT Practitioner 07 June 2013
CHIROPRACTIC -HOW IT AFFECTS YOU. Dr Milan Hari M- CHIRO. S.A GT Practitioner 07 June 2013 Chiropractic Chiropractic focuses on disorders of the musculoskeletal system and the nervous system, and the effects