LOCATION: Outpatient, Hospital
PATIENT: Eric Tayes
ORDERING PHYSICIAN: Frank Gaul, MD
ATTENDING/ADMIT PHYSICIAN: Frank Gaul, MD
RADIOLOGIST: Morton Monson, MD
EXAMINATION: Ultrasound ...
... of both lower extremities; abdomen ultrasound.
CLINICAL SYMPTOMS: Lower extremity swelling, difficulty breathing.
FINDINGS: Ultrasound examination of the deep venous system of both lower extremities is negative. No
evidence of deep venous thrombosis in either lower extremity. The posterior tibial, greater saphenous, and
popliteal through femoral veins are patent and negative for thrombus bilaterally. Normal phasicity. What claim form will be submitted for the radiologist’s services?
claim form cms 1500.
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