Your Name and Names of Physicians Involved
Indicate first & last names, and level (Staff, Fellow, Resident)

Patient Name and MRN

Procedure(s) Performed
IVI cases (Diagnosis & intervention of PVD, including MRA. Applies only to University Hospital and Wishard). Must dictate "This procedure was performed by physician members of the Indiana Vascular Institute."

Summary (Impression)

Clinical History
This must provide justification for the procedure.

Referring Physician and Service

Complications

Contrast: type and amount used

Medications
List of drugs and doses Must dictate "Conscious sedation was monitored by Radiology Nursing Staff"

Technique/Findings
Must dictate "Dr. (attending name) was present"

Plan (if any)

For on call cases performed by the fellow without staff present, you: Must begin dictation with "This procedure was performed at no physician charge to patient." Must NOT dictate "Dr. (attending name) was present."