Adrian_Sampath_Overseas_Case Study_Jan_2017

Adrian Sampath
00040384
Referral Form Information (See appendix 1 for sample)
1. All the client’s demographics were present.
2. The doctors contact, name and signature was present.
3. The client history was that he fell on left shoulder with pain and bugling on arm on flexion.
Query left bicep tendon rupture.
4. The modality and requested scan type was present.
5. Attached was a screening form (see appendix 2) completed and signed by the client to
ensure that the client was MR compatible and confirming all the information.
Figure 2 Showing Original Referral Information
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