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Spice Isle Imaging Center - Make Appointment #2
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D.O.B. day / month / year
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Clinical Data:
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ULTRASOUND PROCEDURE

AREA
Pelvis Trans
Vaginal
Abdomen Abdomen/
Pelvis
Obstetric Carotid
Testicle Thyroid
   
VENOUS
Upper
Extremity

Both

Left  


Right

Lower
Extremity

Both

Left  
 
Right
   
ARTERIAL
Upper
Extremity

Both

Left  
 
Right
Lower
Extremity

Both

 Left  
 
Right
   
 

 

 


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