Patient Name:
John Mcgowan
DOB:
5/22/1932
Procedure Date:
3/18/2022
YDA REQUISITION
1Accession#:
YAR202200001
2Tech:
1.CC
2.JEB
3.KC
4.JG
5.DM
3Procedure:
4Location:
Size:
5
X
6
X
7
mm*
8
or
9
10Color:
1.White
2.Gray
3.Black
4.Tan
11Other:
12Shape:
1.Ellipse
2.Cylinder
3.Round
4.Sphere
5.Piece
6.Flat
7.Raised
13Other:
14Inked:
15How many pieces:
16Sections:
1. Bisected
2. Trisected
3. Tetrasected
4. Serially Sectioned
5. Whole
17Other:
18Number of Cassettes:
19Number of Levels:
20Procedure:
21Diagnosis:
22Ordering Doctor:
Richard Fried MD
These measurements may not correspond to those in vivo*