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  • DentalCT Template

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    Ermir Shabani
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    The dental CT report is for patient John Doe, born April 4, 1963, who underwent a CT exam on May 1, 2012 at the request of Blue Health. The report details the imaging study performed, comparison studies used, scan parameters, clinical history, image quality findings, impression, and is signed by an interpreting dentist/physician on April 2, 2012 with a final report date of April 3, 2012.

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    dental

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    The dental CT report is for patient John Doe, born April 4, 1963, who underwent a CT exam on May 1, 2012 at the request of Blue Health. The report details the imaging study performed, comparison studies used, scan parameters, clinical history, image quality findings, impression, and is signed by an interpreting dentist/physician on April 2, 2012 with a final report date of April 3, 2012.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views1 page

    DentalCT Template

    Uploaded by

    Ermir Shabani
    The dental CT report is for patient John Doe, born April 4, 1963, who underwent a CT exam on May 1, 2012 at the request of Blue Health. The report details the imaging study performed, comparison studies used, scan parameters, clinical history, image quality findings, impression, and is signed by an interpreting dentist/physician on April 2, 2012 with a final report date of April 3, 2012.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
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    of 1

    XXX Dental Practice

    6021University Blvd., Suite #500


    Ellicott City, MD 21043
    Phone (123)123-1234
    Fax (123)123-1234

    Dental CT Report
    Patient Name:
    Sex:

    Doe, John
    Male

    ID Number:
    Date of Exam:

    123456
    5/1/12

    Date of Birth:
    Requesting Provider:

    04/04/63
    Blue Health

    Diagnosis: ______________
    Imaging Study Performed: ____________________
    Comparison Studies: ____________________
    CT Protocol/Scan Parameters: ____________________
    Clinical History/Indications for Scan: ____________________
    Image Quality: ____________________
    Findings: ____________________
    Impression: ____________________

    xxx Interpreting Dentist/Physician (digitally or manually signed)


    Date of interpretation: 4-2-12
    Date of final report: 4-3-12

    IAC Dental CT Report Template

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