Radiology Department University of Cupertino Silicon Valley California, CA 90024 referringPhysician
Name: Birthdate: Accession Number:
name (patientID) dateOfBirth accessionNumber
Cupertino, Saturday, July 23, 2011 Report modality - studyName date Study performed by: performingPhysician - institutionName Indication: Technique: modality: modality, number of images: numberOfImages Quality: Description: Conclusion:
Sincerely, performingPhysician
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