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Form 721 145400.pdf

RADIOLOGY CONTRAST
EVALUATION

Procedure: ______________________________________________ Creatinine: _______________________________________________ Do you have any history of Allergies (medication or foods) or Asthma?
Comments: __________________________________________________________________________________________________________________________________ Do you have any history of Heart Conditions?
Comments: __________________________________________________________________________________________________________________________________ Do you have any history of Chronic or Debilitating Conditions?
Do you take Glucophage, Glucophage XR, Glucovance, Avandamet, Metaglip, Riomet, Altimetformin, Metformin, Glumetz R Apometformin,
Genmetformin, Glycon, Novometformin, Numetformin, Pmsmetformin, Rhometformin, Rhoxalmetformin, Fortamet?

ORDER HISTORY:Have you ever been diagnosed with cancer? If yes, describe: _______________________________________________________________ If yes, have you had radiation or chemotherapy? When did you finish treatments? ________________________________________________ Have you had any previous surgery in the area that you are having scanned today? If yes, when? __________________________________ Describe your surgeries: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Have you had any previous diagnostic exams for same area that you are having scanned today? Describe (MRI, CT Scan, Nuclear Medicine, X-Rays, Ultrasound, Lab Work): ______________________________________________________________________________________________________________________________________________________________________________________________________________________ Why are you having this exam today? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Female Patients: Is there any possibility that you may be pregnant or nursing? Date of Last Menstrual Period: __________________ Explanation about the nature of my procedure has been discussed with me. My questions have been answered and I consent to receive the contrast agent.
Signature of Patient/Guardian: ___________________________________________________________ Date: _________________________________________ If yes, describe: ________________________________________________________________________________________ Type/amount contrast administered: ______________________________________________________ IV Location ____________________________________ Signature of Technologist: _______________________________________________________________

Source: http://brrh.com/pdf/RadiologyContrastEvaluation-145400.pdf

Benefits of estrogen replacement

IHHS Health & Wellness Center 1607 South H Street, Bakersfield, CA 93304 Hormonal, Homeopathic, & Nutritional Services Office (661)-837-0453 FAX (661)-837-0560 Benefits of Estrogen Replacement Bone Prevention of Osteoporosis and bone fractures [Treatment should be initiated at menopause and not 4 to 5 years later to be most effective] Heart Prevention of heart disease b

blutegelversand.ch

Effectiveness of Leech Therapy in Osteoarthritis of the Knee A Randomized, Controlled Trial Andreas Michalsen, MD; Stefanie Klotz, RN; Rainer Lu¨dtke, PhD; Susanne Moebus, PhD, MPH; Gu¨nther Spahn, MD; and Gustav J. Dobos, MD Background: Leech therapy was commonly used in traditional arthritis Index and physical sum score of the Medical Outcomes medicine for treating localized pain.

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