Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Allergy Allergy Audiology Otorhinolaryngology Breast Clinic BRCA Mutation Family History Ca Breast Genetic Susceptibility to Ca Breast High Risk Ca Breast Counseling Other Breast Clinic Risk Assessment Ca Breast Cardiology Amyloid 12 12 12 12 12 12 Cardio Oncology Heart Failure 12 12 12 12 12 Heart Rhythm 12 12 12 12 12 Ischemic Heart Disease 12 12 12 12 12 Marfan Thoracic Aorta Other Cardiology 12 12 12 12 12 Structural Heart Disease (Valve, Congenital, HCM, Pericardial) 12 12 12 12 12 Uneplained Dyspnea CGIM Complimentary General Internal Medicine Dental Specialties Dental Specialties Dermatology Acne 3 12 12 Blistering Disease 3 12 12 Connective Tissue Disease 3 12 12 Dermatology - Inpatient 3 12 12 Diffuse Rash 3 12 12 Diffuse Skin Condition 3 12 12 Genetics - Dermatology 3 12 12 Page 1 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Limited Rash 3 12 12 Limited Skin Condition 3 12 12 Lymphoma of Skin 3 12 12 Melanoma 3 12 12 Oral Disease 3 12 12 Other Dermatology 3 12 12 Pediatric Dermatology 3 12 12 Skin Cancer or History of Skin Cancer 3 12 12 Skin Growths or Keratosis 3 12 12 Vasculitis 3 12 12 Warts 3 12 12 Endocrinology Endocrinology GI & Hepatology Esophageal Disorders:24 PH Study; Esophageal Manometry 12 12 12 12 12 12 12 12 12 GI Neoplasia 12 12 12 12 12 12 12 12 12 HB Neoplasia 12 12 12 12 12 12 12 12 12 Hepatology 12 12 12 12 12 12 12 12 12 Inflammatory Bowel Disease 12 12 12 12 12 12 12 12 12 Jaundice 12 12 12 12 12 12 Malabsorption and Failure to Thrive 12 12 12 12 12 12 Motility Disorders: Anorectal Manometry, Pelvic Floor Testing, Transit Studies 12 12 12 12 12 12 12 12 12 Other GI 12 12 12 12 12 12 12 12 12 Other Hepatology 12 12 12 12 12 12 12 12 12 Pancreatic Disorders 12 12 12 12 12 12 12 12 12 Gynecology/Obstetrics Amenorrhea 3 Colposcopy/ Dysplasia 3 Comple Contraceptive Management 3 Page 2 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Cysts on Ovaries 3 GYN Surgical Oncology 12 12 12 12 3 High Risk OB 12 3 Irregular Periods 3 Other Obstetrics 12 3 Other Gynecology 12 3 Pediatric/ Adolescent Gynecology 12 3 Polycystic Ovary Syndrome 3 Reproductive Endocrinology & Fertility 12 3 Urogynecology 12 12 12 3 Vulvar Disease 3 Hematology Acute Leukemia 6 6 6 6 6 Bone Marrow Transplantation 6 6 6 6 6 Chronic Lymphocytic Leukemia 6 6 6 6 6 Coagulation/ Thrombophilia 6 6 6 6 6 Lymphoma 6 6 6 6 6 Myelodysplastic Syndrome 6 6 6 6 6 Myeloma, Plasma Cell Disorders and Amyloidosis 6 6 6 6 6 Myeloproliferative Disorder 6 6 6 6 6 Non-Malignant Hematology (anemia, iron deficiency, neutropenia, thrombocytopenia, others) 6 6 6 6 6 Other Hematology 6 6 6 6 6 Pediatric Blood Dyscrasias Pediatric Ecessive Bleeding Pediatric Hemophilia Infectious Disease Hematology & Oncology Infectious Disease 12 12 12 12 12 12 12 Orthopedic Infectious Disease 12 12 12 12 12 12 12 Other Infectious Disease 12 12 12 12 12 12 12 Transplant Infectious Disease 12 12 12 12 12 12 12 Travel & Tropical Infectious Disease 12 12 12 12 12 12 12 Medical Genetics Medical Genetics Page 3 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Medical Oncology Brain Cancer 6 6 6 3 6 Breast Cancer 6 6 6 3 6 Childhood Cancer 3 Endocrine Cancer 6 6 6 3 6 GI Cancer 6 6 6 3 6 GU Cancer 6 6 6 3 6 GYN Medical Oncology 6 6 6 3 6 Head/Neck Cancer 6 6 6 3 6 Lung Cancer 6 6 6 3 6 Melanoma 6 6 6 3 6 Other Oncology 6 6 6 3 6 Sarcoma 6 6 6 3 6 Unknown Primary Cancer 6 6 6 3 6 Nephrology and Hypertension Nephrology and Hypertension Neurology Autoimmune 6 3 6 6 Autonomic 3 Behavioral - Cognitive/Dementia 6 6 3 6 Cerebrovascular 6 6 3 6 Delayed Development Milestones 6 3 6 24 24 6 6 Epilepsy/Seizure 6 3 6 6 Headache 6 3 6 Multiple Sclerosis 6 3 6 Neuro Oncology 24 3 6 6 6 6 6 Neuromuscular 3 6 Other Neurology 6 3 6 Pediatric Abnormal or 6 6 3 6 6 Pediatric Involuntary Movements 6 3 6 6 Pediatric Spells 6 3 6 6 Ophthalmology Cornea Page 4 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 COS Glaucoma NeuroOph 24 24 24 24 24 Oculoplastics 3 3 3 3 3 3 3 3 Pediatric (including Peds Neuro) Retina Uveitis Orthopedic Surgery Foot/Ankle Surgery 12 12 12 12 12 12 12 12 Hand Surgery 24 24 24 24 24 24 24 24 Orthopedic Oncology 24 24 24 24 24 24 24 24 24 24 24 24 24 Orthopedic Spine surgery 12 12 12 12 12 12 12 Orthopedic Trauma Other Orthopedic Surgery Pediatric Ortho Surgery 12 12 12 12 12 12 12 12 12 12 12 12 Reconstructive Surgery 12 12 12 12 3 12 12 Otorhinolaryngology Otorhinolaryngology Pain Medicine Advanced Neuromodualtion (Spinal Cord Stimulation, Peripheral Nerve Stimulation- Occipital, Intrathecal Drug 6 6 6 6 6 6 6 Delivery) Cancer Pain 6 6 6 6 6 6 6 Comple Regional Pain Syndrome (Refle Sympathetic Dystrophy, Causalgia) 6 6 6 6 6 6 6 Failed back Surgery Syndrome 6 6 6 6 6 6 6 Other Pain Medicine 6 6 6 6 6 6 6 Postherpetic Neuralgia 6 6 6 6 6 6 6 Radiculopathy (Cervical, Thoracic, Lumbar) 6 6 6 6 6 6 6 Spine (Cervical, Thoracic, Lumbar) 6 6 6 6 6 6 6 Pediatrics Pediatric/Adolescent Gynecology Pediatric Involuntary Movements Pediatric Spells Page 5 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Pediatric Abnormal CXR or Pediatric Asthma Management Pediatric Chronic Cough Pediatric Dyspnea/Shortness of Breath Pediatric Recurrent Pneumonia Pediatric Cancers Pediatric Blood Dyscarsias Pediatric Ecessive Bleeding Pediatric Hemophilia Pediatric Dermatology Pediatric Orthopedic Surgery Pediatric Orthopedic Pediatric: Mayo Clinic Child Abuse Program Pediatric (including Peds Neuro) Physical Medicine & Rehabilitation Physical Medicine and Rehabilitation Psychiatry & Psychology Alcohol Abuse and Addiction (waiting for guidelines) Depression (waiting for guidelines) Other Psychiatry & Psychology (waiting for guidelines) Pain (waiting for guidelines) Pulmonary Abnormal CXR or 24 12 3 Asthma Management 24 3 Chronic Cough 24 3 COPD Management 24 3 Interstitial Lung Disease 24 3 Lung Nodule/Mass 24 12 3 Mycobacterial Disease 24 3 Other Pulmonology 24 3 Pediatric Abnormal CXR or X Pediatric Asthma Management X Pediatric Chronic Cough X Page 6 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Pediatric Dyspnea/Shortness of Breath X Pediatric Recurrent Pneumonia X Pleural 24 3 Pulmonary Vasculitis 24 3 Radiation Oncology Breast Cancer 3 CNS 3 GI Cancer 3 GU Cancer 3 GYN Cancer 3 Head & Neck Cancer 3 Lung/Thoracic Cancer 3 Lymphoma/ Leukemia 3 Other Radiation Oncology 3 Pediatric Cancers 3 Sarcoma 3 Radiology Radiology Rheumatology Rheumatology 12 12 24 12 24 12 12 12 24 12 12 12 12 24 24 Sleep Disorders Sleep Disorders Spine Center Spine Center Sports Medicine Sports Medicine Surgery- Cardiovascular Surgery Surgery- Colon & Rectal Surgery Cardiovascular Surgery Colon & Rectal Surgery Surgery- General Surgery General Surgery Page 7 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 Surgery- Neurosurgery Neurosurgery Surgery- Oral & Maillofacial Surgery Oral & Maillofacial Surgery Surgery- Plastic Surgery Plastic Surgery Surgery- Thoracic Surgery Thoracic Surgery Surgery- Vascular Surgery Vascular Surgery Transplant Center Transplant Center Urology Urology Vascular Center Aneurysm 12 12 12 3 12 Other Vascular 12 12 12 3 12 12 Peripheral Artery Disease 12 12 12 3 12 12 Vascular Wound Care 12 12 12 3 12 Venous Insufficiency 12 12 12 Venous Thrombosis 12 12 12 3 Women's Health Clinic Menopause Management (Hormonal and Non- Hormonal options) Other WHC Guideline to use when specific guidelines have not been identified: Timeline Key Requirement Key Images: Provide most current image for each modality relevant to the = Relevant to request, no time guidelines * Required if applicable to the specific question request within the past 12 months or pertinent. 3 = Most recent completed in past 3 months, or pertinent Required for all cases. Labs & Reports: Provide labs & reports relevant to the request within the 6 = Most recent completed in past 6 months, or pertinent past 12 months or pertinent (10 pages or less). 12 = Most recent completed in past 12 months, or pertinent 24 = Most recent completed in past 24 months, or pertinent Page 8 of 9
Ankle brachial inde Radiation Records (H) Eternal econsult Guidelines Updated 12/9/2016 3 = All completed in past 3 months, or pertinent 6 = All completed in past 6 months, or pertinent 12 = All completed in past 12 months, or pertinent 24 = All completed in past 24 months, or pertinent Page 9 of 9