Tests and Procedures

LABORATORY TESTS

_____ BMP (Basic Metabolic Profile = Sodium, Potassium, Chloride, Carbon Dioxide, Bicarbonate, Glucose, Calcium, Blood Urea Nitrogen, Creatinine)

_____ PT/PTT/INR (Prothrombin Time, Partial Thromboplastin Time, International Normalized Ratio)

_____ Amylase

_____ Blood Alcohol

_____ Blood Cultures

_____ CBC (Complete Blood Count)

_____ Chlamydia/Gonococcal Screen

_____ CK-MB (Creatine Kinase-MB)

_____ D-Dimer

_____ LFTs (Liver Function Tests)

_____ Lipase

_____ Rapid Strep Screen

_____ Lyme Titer

_____ Sedimentation Rate

_____ Monospot

_____ Troponin

_____ Pro BNP

_____ U/A (Urinalysis)

_____ UCG (Pregnancy Test = Urine)

_____ Urine Culture and Sensitivity

Other Laboratory Test: ____________________

DIAGNOSTIC IMAGING TESTS

X-rays Performed:

_____ Ankle

_____ Arm

_____ Cervical Spine

_____ Chest

_____ Foot

_____ Hand

_____ Lower Leg

_____ Lumbar Spine

_____ Wrist

Other X-rays: ____________________

CT Scans Performed:

_____ Abdominal/Pelvic

_____ Head

_____ Kidney Stone Study

Other CT Scans: ____________________

Ultrasounds Performed:

_____ Abdomen

_____ DVT Study

_____ Pelvic

_____ Renal

Other Ultrasounds: ____________________

OTHER TESTS/PROCEDURES

_____ Bladder Scan

_____ Catheterization

_____ Conscious Sedation

_____ Crutch Instruction

_____ Dislocation Reduction

_____ Dressing Change

_____ EKG (Electrocardiogram)

_____ Foreign Body Removal

_____ Incision and Drainage

_____ IV Antibiotics

_____ Joint Aspiration

_____ Pelvic Exam

_____ Splint Application

_____ Suture/Staple

_____ Suture/Staple Removal

Other Tests/Procedures Performed: ____________________