Vascular Interventional Radiology

PROCEDURE:  AV fistulogram Venous angioplasty   CLINICAL HISTORY: Patient is a _____ with history of end-stage renal disease and prior AV fistula placement. Patient with

Patient Name:     ,            DOB:        SEX:     Ordering Physician:     ,       PROCEDURE:     Arm port / Portacath placement with image

PROCEDURE        DATE OF PROCEDURE:     CLINICAL HISTORY:      OPERATOR: John Doe, MD (Attending)/Jane Doe, MD (Fellow) MEDICATIONS:      CONTRAST:      ACCESS SITE:      PROCEDURE:   The risks, benefits, and

Procedure: Bilateral adrenal vein sampling Indication:  Hypertension refractory to medication. Date: 01/01/2022 Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow) Medications: 3 mg IV Versed,

PROCEDURE: Gastrojejunostomy tube check and repositioning with imaging guidance   DATE: 01/01/2022 CLINICAL INDICATION: Mr.  73 year old male with hx of PD dx 12