Preliminary Form

Radiologist:*

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Preliminary Impression Type:*

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Hospital Location:*

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Patient Name:*

ACC - file upload:

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ACC:

Modality:*

CT

MR

US

XR

Other

Modality other details:*

Body Part:*

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Body part other details:*

Radiologist Preliminary Findings:*

Findings called: (To, By, and When)*

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