Vascular/Interventional Radiology Services Forms
To schedule an appointment, please call Centralized Scheduling at 574.647.7700. Fax orders to 574.647.2200.
- Vascular/Interventional Radiology Order Form (PDF)
- Exam Preps and Directions to the Facility (PDF)
- Detailed instructions for filling out the order form (PDF)
- Request more Vascular/Interventional Radiology order forms
Services included in this order form are:
- Ablation
- Abscess Drain
- Alcohol injection of Liver
- Angioplasty/Stent
- Aortogram with runoff
- Arteriogram
- Arthrogram
- Aspiration
- Biliary Catheter
- Biopsy
- Bone Marrow Biopsy
- Chest Tube Placement
- Chest Tube Pleurodesis
- Declotting of Fistula
- Discectomy/Disc Aspiration
- Dye Study of Port
- Embolization
- Facet Injection
- Fistulogram
- Gallbladder Drain
- IVC Filter/Inferior Vena Cavagram
- Lumbar Puncture
- Opening Pressures
- Methotrexate Injection (Intrathecal)
- Myelogram
- Needle Lung Localization
- Nephrostomy Catheter
- Neural Foraminal Injection/
Nerve Root Block - Paracentesis
- Perm Cath/Dialysis Catheter
- PICC/Peripherally Inserted Catheter
- Retrieval of Foreign Body
- Sialogram
- Transhepatic Cholangiogram
- Thrombolysis Infusion (TPA)
- T.I.P.S./Transhepatic Intrahepatic Portosystemic Shunt
- Thoracentesis
- Vascular CTA’s
- Vascular Ultrasound
- Vertebroplasty
- Venogram
- Uterine Fibroid Embolization