Pregnancy ultrasound form

Computed Tomography Scan Form
Patient Name: ________________________ Age: ______________________ Health Card No: ______________________ Fees: ______________________ Nationality: __________________________ Date: ______________________ Telephone No: ________________________ Time: ______________________ Location:
Dubai Hospital at Radiology Department Ultrasound Reception Purpose:
It is a useful examination because it can provide several types of tissues, bone, and blood vessels—with great clarity. Plus this it is very safe and painless. But the radiation exposure is slightly higher than the routine x-ray. Preparation:
If you are scheduled to get an exam "with contrast or x-ray dye" you should not eat
or drink anything for four hours prior to the procedure. You will receive instructions
about this from your physician or another healthcare professional. You will need to let your physician know if you have ever had a reaction to any contrast dye, or allergic to iodine or seafood added to this if the patient is female please let the technologist know before your exam will start. Beside this if you are diabetic and take insulin, you must consult with your doctor to adjust your dose. You should not take insulin if you Before getting an appointment just inform the clerk that you are a diabetic patient and request to be done in the early morning. If you take Glucophage (Metformin), you may take the medicine before the x-ray examination but cannot resume taking it for
at least 48 hours after the study is completed. Also, you must consult with the
doctor who ordered the study to find out when it is safe to resume taking Glucophage. Please bring your medication list if you are under any medication. Procedure:
The procedure can take between 10-45 minutes depending on the exact test performed. If you prefer not to change into a patient gown, it is advised that you wear loose fitting, comfortable clothing without metal parts. If you are scheduled for any head exams, earrings, glasses, hearing aids and dentures must be removed prior to If you are scheduled for an abdominal CT, this means you will be given an equivalent of 36 ounces of barium to drink over 30 to 45 minutes prior to your exam. Upon the exam table you may receive approximately 3 to 4 ounces of bicarbonate water to help visualize the stomach during your exam. An IV line may need to be established so that IV contrast can be given just before imaging begins. The insertion of the IV line may give you some discomfort. The contrast may make you feel warm all through your body. Some patients experience a metallic taste during the injection. These sensations last until the injection is completed. Patients under the age of 18 years need to be accompanied by an adult (parent or We strongly advise that CT patients not bring children along without another responsible supervising adult. We cannot provide supervision for the children After Care:-
If your examination was non-contrast you will be able to resume normal activities immediately. Or your examination was with contrast media then you have to drink lots of water to get flush the dye from your body. In the end you have to see your doctor for complete results. For further information related to your exam please call (215) 662-3142 and speak with a CT technologist or Radiology nurse. Contact Number for appointment:-
Sunday – Thursday from 12pm – 2pm: - 04-2195608 or
During weekend (Friday-Saturday) and afternoon: - 04-2195600 / 04-2195601
Fax No: - 04-2195613

Source: http://web.dohms.gov.ae/dh/dubairadiology/Preparation/ct.pdf