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Mrs. KATE ALLENA
Chart ID
11111D1
Age
69 Years
DOB
07-23-1957 (66 years)
Gender
Male
Phone
+1-212-456-7890
Email
ibeothpeter@gmail,com
Enrolment Type
Non-Dual Aged
Provider
ibeothpeter@gmail,com
Appointment Date
11-02-2023
Risk Score
2.55
INS Name
Medical Health Insurance
INS ID
14XE-YT78-8901
High Risk
Diagnostic Ordered
No
Yes
Enable
MR
X-Ray
CT
MAMMOGRAPHY/BONE DENSITY
ULTRASOUND
PET/CT
NUCLEAR MEDICINE
FLUOROSCOPY
SPECIAL PROCEDURES
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
Chest PA/LAT
Abdomen/KUB
Skull
Nasal Bones
Sinuses
Rib Series
B
R
L
Cervical Spine
Thoracic Spine
MR Brain
Clavicle
R
L
Clavicle
R
L
Clavicle
R
L
MR Chest
R
L
MRCP
R
L
Hand
R
L
Fingers
R
L
Hand
R
L
Fingers
R
L
Hand
R
L
Fingers
R
L
Hand
R
L
Fingers
R
L
Hand
R
L
Fingers
R
L
Hand
R
L
Fingers
R
L
Hand
R
L
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
X-Ray orbits if indicated
X-Ray orbits if indicated
Carotid
Circle of Willis
Aorta
Renal
Run-off
Other
MR Brain
MR Abdomen - Specify
MR Chest
MRCP
MR Pelvis - Specify
MR Prostate
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Breast
R
L
MR Wrist
R
L
MR Arthrogram - Specify
MR Prostate - w/3D
MR Prostate - w/ contour imaging
MR Other
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