Strong Memorial Hospital Exam Requisitions

Chest Examination
(SMH 516MR)

MRI Examination and Patient Screening Form
(SMH 515)

Special Examination
(SMH 519)

Nuclear Medicine Examination
(SMH 525)

CT Examination Abdomen, Pelvis, Chest, Extremity
(SMH 523)

General Examination
(SMH 517)

CT Examination Head, Neck & Spine
(SMH 522)

Orthopaedic Examination
(SMH 320MR)

Ultrasound Examination
(SMH 520)

Request for Venous Access
(SMH 1201)

Special Examination - Lumbar Puncture and/or Intrathecal Chemotherapy
(SMH 519 Chemo)

Special Examination - Myelogram (SMH 519 Myelo)

Special Examination - Neuroradiology Angiogram
(SMH 519 NeuroAngio)

Special Examination - Interventional Neuroradiology
(SMH 519 IV Neuro)

Special Examination - Celiac Ganglion Block
(SMH 519 Celiac)

Special Examination - Dacrocystogram
(SMH 519 Dacro)

Special Examination - Discogram
(SMH 519 Disco)

Special Examination - Facet Joint Injection
(SMH 519 Facet)

Special Examination - CT-guided Neuro Biopsy or Disc Aspiration (SMH 519 NeuroBx)

Special Examination - Sialogram
(SMH 519 Sialo)

Special Examination - Pudenal Nerve Block
(SMH 519 PNB)

PET/CT Scan at University Imaging at Science Park
(SHPET/CT Req)

CT Examination Head, Neck & Spine - CT Cisternogram with Intrathecal Contrast
(SMH 522 Cisterno)

CT-Guided Cervical Spine Biopsy
(SMH 522 C-SpineBx)

MRI Examination and Patient Screening Form - TMJ MRI (SMH 515 TMJ)

MRI Examination and Patient Screening Form - MRI Brain for Alzheimer (SMH 515 Alzheimer)