PLEASE OBTAIN PRE-Iodine 131 SERUM LABS:LABLEICD10: Thyroid Cancer (C73), Postop Hypothyroidism (E89.0), H/o Thyroid cancer (Z85.850),

[X] 84443 TSH, [] 8396 HCG, [X] CPT: 84432 Thyroglobulin (Tg)[X] CPT: 86800 Anti-thyroglobulin anti-bodies (TgAb)________________Erik Sloman-Moll

Thyroid Stimulating Hormone (TSH). See the section on thyroid hormone replacement therapy, linked on the left side of this page. Thyroglobulin (Tg): Thyroglobulin is a protein produced by thyroid cells (both normal and cancerous cells). After removal of the thyroid gland, Thyroglobulin can be used as a "cancer marker." Its number should be as low as possible. Sometimes this is termed "undetectable.” After your surgery and RAI, it may take months or years for the Tg number to come down to zero or undetectable.

A positive Tg test indicates that thyroid cells, either normal or cancerous, are still present in your body. Depending on the level of Tg in your blood, your doctor may want to monitor you more closely with other tests or scans and/or prescribe additional treatment.

If you did not receive RAI, your Tg level will probably be detectable. This is because some remnant thyroid tissue nearly always remains in your neck after surgery. If you had a lobectomy rather than a thyroidectomy, your remaining lobe will almost certainly produce Tg. However, it is still helpful to follow your Tg levels over time. If Tg levels increase, your doctor may recommend further imaging studies to locate the source.

From time to time, your doctor may recommend what is called a “stimulated Tg” measurement. This means that your TSH is elevated, by withdrawal from thyroid hormone or by receiving injections of the drug Thyrogen, and then your Tg is measured. Thyroglobulin testing can be more accurate when your TSH level is elevated. Anti-thyroglobulin anti-bodies (TgAb): Some people produce anti-thyrogloblin antibodies. These are not harmful. However, they mask the reliability of the Tg value. If you have TgAb, imaging studies may be used to monitor for persistent or recurrent disease. Sometimes the antibodies disappear over time, although not always.

PLEASE OBTAIN POST-Iodine 131 SERUM LABS:LABLEICD10: Thyroid Cancer (C73), Postop Hypothyroidism (E89.0), H/o Thyroid cancer (Z85.850),

[X] CPT: 84432 Thyroglobulin (Tg)________________Erik Sloman-Moll

LABLEICD10: C73, E89.0,

PHYSICIAN'S ORDERS

Date HR

Diagnositic Testing: ThyrogenDiagnosis: Thyroid Cancer (193)

Day #1: Monday 0800 AM report to Admission Desk then to Radiology Department for first of two injections of Thyrogen 1) Inject 0.9mg Thyrogen (Thyrotropin Alpha) Intramusculary

Day #2: Tuesday 0800 AM report to Admission Desk then to Radiology Department for second of two injections of Thyrogen, 24 hours after first injection 1) Inject 0.9mg Thyrogen (Thyrotropin Alpha) Intramusculary 2) Lab: serum levels Tg (Thyroglobulin) TgAb (Thyroglobulin Antibody), TSH and HCG (for females)

Day #3: Wednesday 0800 AM report to Admission Desk then to Radiology Department for administration of Radioactive Iodine Dose of I-131, 24 hours after second dose of Thyrogen 1) Administer orally 4mCi (148 MBq) 24 hours after final (second) dose of Thyrogen

Day #4: Thursday No therapy or review

Day #5: Friday 0800 AM report to Admission Desk then to Radiology Department for for Whole Body Scan 1) 48 hours after administration of I-131 Dose, Whole Body Scan 2) Lab: Blood test for serum levels Tg (Thyroglobulin)

Call my office if you have any questions 5/14/2023 10:12 PM ERIK R. SLOMAN-MOLL MD

Request for CT Neck(70490) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a CT Neck with a persistent right-left neck mass (784.2), right-left neck pain (723.1), oro-pharyngeal dysphagia (787.2 ). CT requested to evaluate for possible inflammation, fractures or tumors. (76377) 3D reconstruction with independant station postprocessing indications: Evaluation of congenital skull abnormalities, Complex facial fractures , Preoperative planning for complex surgical cases. Quality of Study: Excellent, sharp well defined structures and no motion artifactTechnique: 40 20 7 sec scan Good, well defined structures with little motion artifact Marker placed over the right-left mass. Adequate, motion artifact and positioning limit the image, but the important landmarksComparisons: No previous films known, US Neck pending can still be seen Previous studies, but only reports are available: Poor, motion artifact and positioning limit the usefulness of this study Previous CT films reviewed: Date: Distorted, motion artifact and positioning make it difficult to draw any conclusionsFindings: Nasal Cavity: Portions in the field of view are normal. Sinus: Portions in the field of view are normal.RIGHT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick. normal ======= ============= =========== === Atrophic ============= ============= ============= ===========

mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence LEFT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick.normal ======= ============= =========== === Atrophic ============= ============= ============= ===========mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence T-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ears and ossciles are normal, inner ears and orbits appear grossly normal. middle tympanic ossicles cochlea vestibule vestibular cochlear facial n. semicir. internal auditory external carotid jugular TMJ

ear cleft membr. aqueduct aqueduct canal canals canal canal canal canal not seen +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++++++++++ +++++ +++++ +++++ ++++normal ===== ===== ===== ===== ===== ===== ===== ===== ===== ============= ===== ===== ===== ====abnormal R L R L R L R L R L R L R L R L R L R mm, L mm R L R L R L R L

high jug bulbMastoid Aeration: R normal sclerotic: mild-mod-sev-"Cue ball", L normal sclerotic: mild-mod-sev-"Cue ball"Neck: Suprahyoid: Infrahyoid: Glands:

naso- oro- oral paraphar. retrophar. larynx hypo- supra- thyroid parotid sub- thoracic lymph vascularpharynx pharynx cavity space space pharynx glottis mandible inlet nodes structures

not seen R L ++ R L + R L + R L + R L + R L + R L + R L + R L + R L + R L + R L + R L + R L +normal R L = R L = R L = R L = R L = R L = R L = R L -- R L = R L = R L = R L = R L = R L =abnormal R L R L R L R L R L R L R L R L R L R L R L R L R L R L

Surface: skin contours are normalInner air-tissue surface: normal surface, nasal and pharyngeal contours are grossly normalBony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes (<3cm)Impression: normal exam, no major abnormality. Size of chest limited the view of the lower neck structures.Impression: normal exam, no major abnormality. normal and stable postsurgical changes with evidence of ongoing disease. RIGHT: mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps

mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

LEFT: mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps

mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

Rec: Consider Ultrasound to evaluate lower neck structures. Consider a study with IV contrast to assess the vascular and soft tissue structures better. Consider Nasal Endoscopy, Consider Flexiable Laryngoscopy, Concider other further studies: _________ Dicated:

*Ultrasound Neck(76536) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a US Neck right-left neck mass (784.2), right-left neck pain (723.1), oro-pharyngeal dysphagia (787.23). US requested to evaluate for possible inflammation, cysts or tumors.Technique: Gray scale ultrasound and color Doppler were utilized to evaluate the thyroid gland.Quality of Study: Excellent, sharp well defined structures and no motion artifact Good, well defined structures with little motion artifact Adequate, motion artifact limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusionsComparisons: No previous films known Previous studies, but only reports are available: Previous Ultrasound of the neck done on _________ showes _______________ Previous CT films reviewed: Date: Today CT NeckFindings: Neck:RIGHT: Suprahyoid: Infrahyoid: Glands:

paraph. retroph. larynx hypo- supra- thyroid parotid sub- thoracic lymph vascularspace space phary. glottis mand. inlet nodes structures

not seen normal abnormal

LEFT: Suprahyoid: Infrahyoid: Glands: paraph. retroph. larynx hypo- supra- thyroid parotid sub- thoracic lymph vascularspace space phary. glottis mand. inlet nodes structures

not seen normal abnormal

Thyroid: (Long) x (Anterior-Posterior) x (Transverse)Right: The thyroid lobe is x x mm in size

without focal lesions. with microcalcifications.with increased vascularity.with one lesion, hyper-hypo-echogenic x x mm in the superior-mid-inferior pole.with multiple nodules, largest x x mm in the superior-mid-inferior pole.

Left: The thyroid lobe is x x mm in size without focal lesions.

Isthmus: is x x mm in size without focal lesions.

Bony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes (<3cm)

Impression: normal exam, no major abnormality.

No change from ____ ultrasound.

Rec: Follow up with the ordering doctor for discussion of results and plans. Consider thyroid scan. Consider needle biopsy. Consider repeat Ultrasound in 3-6-12months.Dictated:

Request for Maxillary Balloon Sinuplasty«NameLastFirst» «DOB» proposed DOS:Order: «Today» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID»

Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID»

Clinical Indications: «Patient.Age» old «Sex» presents for a Maxilary Sinus Balloon in concert with other procedures

Symptoms: Chr Bilateral Maxillary Headaches months, lasting mild, moderate, severe

hitting maxilla, head-banging recurrent facial (maxilla) swelling

Despite Meds: nasal steroids, antihistamines, over the counter decongestants, monteleukast ( not approved by insurance) antibiotics

Exam: Routine nasal, bilateral maxillary ostium stenosis observed Rigid Nasal endoscopy, bilateral maxillary ostium stenosis observed Rigid Nasopharyngoscopy, bilateral maxillary ostium stenosis observed Flexiable Nasolaryngoscopy, bilateral maxillary ostium stenosis observed

Xrays: Sinus plainfilms: CT Sinus: B-cone CT not allowed by insurance, and Full CT considered too much radiation for this age

Cofactors: suspected source of chronic infections ( /yr x yrs) to throat, to ears aggrevating asthma/bronchitis

Progress note documenting history sent References sent with request Date:

Request for CT Head(70450) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a CT Skull/Scalp with a persistent right-left frontal-parietal-temporal-occipital mass (784.2), trauma to head (959.09). CT requested to evaluate for possible skull fractures or scalp tumors, this CT is not expected to exam brain structures.

(76377) 3D reconstruction with independant station postprocessing indications: Evaluation of congenital skull abnormalities, Complex facial fractures , Preoperative planning for complex surgical cases.

Technique: 40 20 7 sec scan Marker placed over the right-left frontal-parietal-temporal-occipital mass.

Quality of Study: Adequate, motion artifact and positioning limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusions

Comparisons: No previous films known Previous studies, but only reports are available: Previous CT films reviewed: Date:

Findings: Nasal: Portions in the field of view are normal.

not seenSinus: Portions in the field of view are normal.

not seenBrain: Extra-axial spaces: Portions in the field of view are normal.

not seenIntracranial hemorrhage: Portions in the field of view are normal.

not seenVentricular system: Portions in the field of view are normal.

not seen

Basal cisterns: Portions in the field of view are normal. not seen

Cerebral parenchyma: Portions in the field of view are normal. not seen

Midline shift: Portions in the field of view are normal. not seen

Cerebellum: Portions in the field of view are normal. not seen

Brainstem: Portions in the field of view are normal. not seen

Calvarium: normal Portions in the field of view are normal. not seen

Vascular system: Portions in the field of view are normal. not seen

Visualized orbits: normal Portions in the field of view are normal. not seen

Visualized upper cervical spine: Portions in the field of view are normal. not seen

Sella: Portions in the field of view are normal. not seen

Skull base: Anterior: Portions in the field of view are normal. not seen

Middle: Portions in the field of view are normal. not seen

Posterior: Portions in the field of view are normal. not seen

T-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ears and ossciles are normal, inner ears and orbits appear grossly normal.

not seenSurface: skin contours normal, contours along the pharynx are normal Bony landmarks: no fractures, no bone loss/erosion of skull.

Impression: normal exam, no major abnormality. Beam power limits the view of the brain structures.

Rec: Follow up with the ordering doctor for discussion of results and plans. Consider full power CT or MRI with Gadolinium to evaluate brain structures.Consider a study with IV contrast to assess the vascular structures better.

Dictated

Request for CT Neck(70490) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a CT Neck with a persistent right-left neck mass (784.2), right-left neck pain (723.1), oro-pharyngeal dysphagia (787.23). CT requested to evaluate for possible inflammation, fractures or tumors. (76377) 3D reconstruction with independant station postprocessing indications: Evaluation of congenital skull abnormalities, Complex facial fractures , Preoperative planning for complex surgical cases. Quality of Study: Excellent, sharp well defined structures and no motion artifactTechnique: 40 20 7 sec scan Good, well defined structures with little motion artifact Marker placed over the right-left mass. Adequate, motion artifact and positioning limit the image, but the important landmarksComparisons: No previous films known can still be seen Previous studies, but only reports are available: Poor, motion artifact and positioning limit the usefulness of this study Previous CT films reviewed: Date: Distorted, motion artifact and positioning make it difficult to draw any conclusionsFindings: Nasal Cavity: Portions in the field of view are normal. Sinus: Portions in the field of view are normal.RIGHT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick. normal ======= ============= =========== === Atrophic ============= ============= ============= ===========

mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence LEFT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick.

normal ======= ============= =========== === Atrophic ============= ============= ============= ===========mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence T-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ears and ossciles are normal, inner ears and orbits appear grossly normal. middle tympanic ossicles cochlea vestibule vestibular cochlear facial n. semicir. internal auditory external carotid jugular TMJ

ear cleft membr. aqueduct aqueduct canal canals canal canal canal canal not seen +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++++++++++ +++++ +++++ +++++ ++++normal ===== ===== ===== ===== ===== ===== ===== ===== ===== ============= ===== ===== ===== ====abnormal R L R L R L R L R L R L R L R L R L R mm, L mm R L R L R L R L

high jug bulbMastoid Aeration: R normal sclerotic: mild-mod-sev-"Cue ball", L normal sclerotic: mild-mod-sev-"Cue ball"Neck: Suprahyoid: Infrahyoid: Glands:

naso- oro- oral paraphar. retrophar. larynx hypo- supra- thyroid parotid sub- thoracic lymph vascularpharynx pharynx cavity space space pharynx glottis mandible inlet nodes structures

not seen R L ++ R L + R L + R L + R L + R L + R L + R L + R L + R L + R L + R L + R L + R L +normal R L = R L = R L = R L = R L = R L = R L = R L -- R L = R L = R L = R L = R L = R L =abnormal R L R L R L R L R L R L R L R L R L R L R L R L R L R L

Surface: skin contours are normalInner air-tissue surface: normal surface, nasal and pharyngeal contours are grossly normalBony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes (<3cm)Impression: normal exam, no major abnormality. Size of chest limited the view of the lower neck structures.Impression: normal exam, no major abnormality. normal and stable postsurgical changes with evidence of ongoing disease. RIGHT: mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps

mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

LEFT: mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps

mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

Rec: Consider Ultrasound to evaluate lower neck structures. Consider a study with IV contrast to assess the vascular and soft tissue structures better. Consider Nasal Endoscopy, Consider Flexiable Laryngoscopy, Concider other further studies: _________ Dicated

Request for CT Sinus(70486) «NameLastFirst» «DOB»Order: «Today» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a CT Sinus with chronic midface-periorbital-frontal-vertex headaches (R51) despite multiple courses of antibiotics, over the counter decongestants, nasal steroids, antihistamines and leukotriene inhibitors. Clinically chronic sinusitis (J32.9). CT is requested to evaluate for possible acute & chronic inflammation, fungal infections and tumors.CT TMJ persistant right-left jaw pain (R07.0), with right-left temporal mandibular joint tenderness & click. CT requested to evaluate Temoporal Mandibular Joint for inflamation, destruction and neoplasm.CT Face with a suspicious ___ cm right-left swelling (R22.0), chronic pain (R07.0) to the ______. CT requested to evaluate for possible inflammation and neoplasm.

CT Mandible with trauma to the face (959.09), nasal fracture (802.0-1), unspecific malocclusion (524.4), trismus (781.0), injury in sports without fall (E91.70), fall (E88. ), assault (E96. ), concussion coma (850.11), diplopia (368.2), paresthesia to face/neck (782.0), subcutaneous emphysema (958.7). CT requested to evaluate the integrity of the mandible, maxilla and the joints. (76377) 3D reconstruction with independent station post processing indications: Evaluation of congenital skull abnormalities, Complex facial fractures, Preoperative planning for complex surgical cases.Technique: 40 20 7 sec scan Quality of Study: Excellent, sharp well defined structures and no motion artifact Marker placed over the right-left mass. Good, well defined structures with little motion artifact

Adequate, motion artifact and positioning limit the image, but the important landmarks Comparisons: No previous films known can still be seen Previous studies, but only reports are available: Poor, motion artifact and positioning limit the usefulness of this study Previous CT films reviewed: Date: Distorted, motion artifact and positioning make it difficult to draw any conclusionsFindings: Nasal Cavity: Portions in the field of view are normal. Sinus: Portions in the field of view are normal.RIGHT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick. normal ======= ============= =========== === Atrophic ============= ============= ============= ===========

mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence LEFT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick.normal ======= ============= =========== === Atrophic ============= ============= ============= ===========mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence

T-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ears and ossciles are normal, inner ears and orbits appear grossly normal. middle tympanic ossicles cochlea vestibule vestibular cochlear facial n. semicir. internal auditory external carotid jugular TMJ

ear cleft membr. aqueduct aqueduct canal canals canal canal canal canal not seen +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++++++++++ +++++ +++++ +++++ ++++normal ===== ===== ===== ===== ===== ===== ===== ===== ===== ============= ===== ===== ===== ====abnormal R L R L R L R L R L R L R L R L R L R mm, L mm R L R L R L R L

high jug bulbMastoid Aeration: R normal sclerotic: mild-mod-sev-"Cue ball", L normal sclerotic: mild-mod-sev-"Cue ball"TMJ: RIGHT soft tissue loss of joint erosion of LEFT soft tissue loss of joint erosion of

calcification space condyle calcification space condylenone ------------------ ---------------------- ---------------------- ---------------------- none ----- ---------------------- ---------------------- ----------------------mild mild mod mod sev sev Face: Soft Tissue structures along the forehead, orbits, nose, maxilla and mandible are normal without subcutaneous air, fluid pockets or cysts or any masses. There is a ____mm by ____mm solid mass ______Mandible: Teeth are appropriate for age and appear to be in normoculssion. The forehead, nasal bones, orbital rims, maxilla and mandible show no sign of fractures. There is disruption _______Surface: skin contours are normalInner air-tissue surface: normal surface, nasal and pharyngeal contours are grossly normalBony landmarks: no fractures, no bone loss/erosion, no bone overgrowthImpression: normal exam, no major abnormality. normal and stable postsurgical changes with evidence of ongoing disease. RIGHT: mild-moderate-severe calcification of TMJ, mild-moderate-severe loss of joint space, mild-moderate-severe loss of bone mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

LEFT: mild-moderate-severe calcification of TMJ, mild-moderate-severe loss of joint space, mild-moderate-severe loss of bone mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

Rec: Consider Nasal Endoscopy, Consider further studies: _________ Dictated

Request for CT T-Bone(70480) «NameLastFirst» «DOB»Order: «Today» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a CT T-BONE: This patient presents with a persistent right-left conductive hearing loss (H90 0 11 12 2), a chronic right-left tympanic perforation (H72...) despite normal middle ear pressures. No improvement with treatment of over the counter decongestants, nasal steroids, antihistamines and leukotriene inhibitors. CT is requested to evaluate for possible acute & chronic inflammation, sclerosis of the mastoids/ossicles/tympanic membranes and tumors. CT will help decide if tympanoplasty, tympanomastoidectomy or other surgeries should be considered. CT T-bone (Revision) for a previous history of surgery ____________ to the right-left ear for chronic mastoiditis (383.1), cholesteatoma (385.3 ). CT is requested to assess for residual disease and the need for revision surgery.CT T-Bone (Congenital) for a congenital ear disease (744.00), right-left microtia (744.23), right-left sensory neural hearing loss (389. ). CT is requested to classify the defect and evaluate for underlying etiologies.CT IAC for a suspicious right-left- asymetric sensory neural hearing loss (389.15-389-16), right-left- asymetric Auditory Brainstem Response (389.12-389.13), tinnitis (388.31), dizziness (780.4), vertigo (389.10). An MRI was first considered, but the patient has metal implants, _________ is too nervous, anxious and claustrophobic to tolerate an MRI without sedation. CT requested to evaluate for possible acoustic neuroma and neoplasm.CT Orbit for trauma to the face (959.09), trauma to the eye (870. ), right-left eyelid swelling (374.82), right-left eye swelling (372.92). CT requested to evaluate for possible inflammation, fractures or tumors. (76377) 3D reconstruction with independant station postprocessing indications: Evaluation of congenital skull abnormalities, Complex facial fractures , Preoperative planning for complex surgical cases.Technique: 40 20 7 sec scan Quality of Study: Excellent, sharp well defined structures and no motion artifact Marker placed over the right-left mass. Good, well defined structures with little motion artifact

Adequate, motion artifact and positioning limit the image, but the important landmarks Comparisons: No previous films known can still be seen Previous studies, but only reports are available: Poor, motion artifact and positioning limit the usefulness of this study Previous CT films reviewed: Date: Distorted, motion artifact and positioning make it difficult to draw any conclusionsFindings: Nasal Cavity: Portions in the field of view are normal. Sinus: Portions in the field of view are normal.RIGHT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick. normal ======= ============= =========== === Atrophic ============= ============= ============= ===========

mild mild mod mod sev sev opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence LEFT: Sept.dev. Inf.Turb.enlg. Mid.Turb.aerat. Front.muco.thick. Max.muco.thick. Ant.Eth.muco.thick.Pos.Eth.muc.thick.

Sphen.muco.thick.normal ======= ============= =========== === Atrophic ============= ============= ============= ===========mild mild mod mod sev sev

opacified polyps mucocele/retension cyst small-med-large small-med-large small-med-large small-med-large

small-med-large stenotic ostium (can't see) with large Agar with large Haller NA NA

Odini air-fluid level dehiscence T-bone: middle tympanic ossicles cochlea vestibule vestibular cochlear facial n. semicir. internal auditory external carotid jugular TMJ

ear cleft membr. aqueduct aqueduct canal canals canal canal canal canal not seen +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++ +++++++++++++ +++++ +++++ +++++ ++++normal ===== ===== ===== ===== ===== ===== ===== ===== ===== ============= ===== ===== ===== ====abnormal R L R L R L R L R L R L R L R L R L R mm, L mm R L R L R L R L

high jug bulb

Mastoid Aeration: R normal sclerotic: mild-mod-sev-"Cue ball", L normal sclerotic: mild-mod-sev-"Cue ball" Microtia Grade R R (1) just small auricle (2) stenotic EAC (3) no EAC (4) no auricle, L (1) just small auricle (2) stenotic EAC (3) no EAC (4) no auricle Cong Deform R L Michel aplasia: complete vestibular aplasia R L cochlea hypoplasia: small

R L cochlear aplasia: no cochlea R L Mondini deformity incomplete partition 2: 1.5 turns, cystic apex and middle cochlea

R L common cavity: vestibule & cochlear in one cyst R L semicircular canal deformities R L incomplete partition 1: cochlea has no modiolus R L enlarge vestibular aqueduct: greater than 1.5mm

Atresia (J scale) stape(2) + oval wind(1) + middle ear(1) + facial n(1) + malleus-incus(1) + incus-stape(1) + mast devel(1) + round wind(1) + outer(1) = /10,Orbit: mass? globe orbit preseptal optic n. extraoc. lacrimal orbital brain cavenous nasal maxilla

soft tiss. complex muscles apparat. apex sinus bonenormal ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== ===== =====

abnormal R L R L R L R L R L R L R L R L R L R L R L R LFace: Soft Tissue structures along the skull, mastoids and auricles are normal without subcutaneous air, fluid pockets, cysts or any masses. There is a ____mm by ____mm solid mass ______Surface: skin contours along the head and auricles are normalInner air-tissue surface: normal surface, nasal and pharyngeal contours are grossly normalBony landmarks: no fractures, no bone loss/erosion of mastoids, scutums, ossicles, no bone overgrowth,

Impression: normal exam, no major abnormality. normal and stable postsurgical changes with evidence of ongoing disease. RIGHT: mild-moderate-severe calcification of TMJ, mild-moderate-severe loss of joint space, mild-moderate-severe loss of bone mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

LEFT: mild-moderate-severe calcification of TMJ, mild-moderate-severe loss of joint space, mild-moderate-severe loss of bone mild-moderate-severe septal deviation, mild-moderate-severe-opacified acute-chronic frontal sinusitis, mild-moderate-severe inferior turbinate hypertrophy, mild-moderate-severe-opacified acute-chronic maxillary sinusitis, mild-moderate-severe conch bullosa, mild-moderate-severe-opacified acute-chronic anterior-posterior ethmoid sinusitis, mild-moderate-severe maxillary retention cyst, mild-moderate-severe-opacified acute-chronic sphenoid sinusitis, stenotic maxillary-frontal-sphenoid ostium inspissated secretions suggesting fungal sinusitis polyps mild-moderate-severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital-retraction pocket-attic-antrum-mastoid-diffuse cholesteatoma, possible tympanic perforation,

Rec: Consider Nasal Endoscopy, Consider further studies: _________ Dictated

Ultrasound Guided Biopsy(76942) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a US Guided Biopsy of a mm Right Left Neck Mass (784.2) Lymphadenopathy (785.6) Thyroid Nodule (241.0) Nodules (241.1) seen on previous films. US is requested to improve the accuracy and safety of a biopsy.Quality of Study: Excellent, sharp well defined structures and no motion artifact

Good, well defined structures with little motion artifact Adequate, motion artifact limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusionsComparisons: Previous studies, but only reports are available: Previous Ultrasound of the neck done on _________ showes _______________ Previous CT films reviewed: Date: RIGHT Thyroid Lobe : no nodules seen (60100:RTx )Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Thyroid ISTHMUS : no nodules seen (60100x )R L x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent R L x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent LEFT Thyroid Lobe : no nodules seen (60100:LTx )Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent

RIGHT Neck : no mass seen (10021:RTx )Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent LEFT Neck : no mass seen (10021:LTx )Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Rec: Follow up with the ordering doctor for discussion of results and further plans. Dictated:Transcribed:.

*«NameLastFirst» «DOB» Disclosure and Consent for Medical and Surgical Procedures «Today» «Now»

TO THE PATIENT: You have the right, as a patient, to be informed about your condition and the recommended surgical or medical procedure to be used so that you may make the decision whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so you may give or withhold your consent to the procedure.

1. I hereby voluntarily request and authorize Dr. Erik R. Sloman-Moll as my physician, and such associates, technical assistants and other health care providers as they may deem necessary, to treat my condition which has been explained to me as: %

2. I understand that the following medical and/or surgical procedures are planned for me and I voluntarily consent and authorize the following procedure(s): %

3. I understand that my physician may discover other or different conditions which require additional or different procedures than those planned. I authorize my physician, and such associates, technical assistants and other health care providers to perform such other procedures which are advisable in their professional judgment.

4. I understand that no warranty or guarantee has been made to me as to result or cure.

5. Just as there may be risks and hazards in continuing my present condition without treatment, there are also risks and hazards related to the performance of the medical and/or surgical procedures planned for me. I realize that common to medical and/or surgical procedures is the potential for infection (increased chances with diabetes, and/ or weight problems), blood clots in veins and lungs, hemorrhage, allergic reactions, and even death. I also realize that the following risks and hazards may occur in connection with this particular procedure: Biopsy: bleeding, bruising, infection, pain, need for more invasive procedure

6. (Patient’s Initials) _____ I DO CONSENT / _____ I DO NOT CONSENT for Place of the People Ambulatory Center to dispose of any tissue, body parts and/or limbs obtained by and through the above referenced diagnostic test or procedure. If I do not consent, such disposal should be accomplished in the following manner: ___________________________

7. (Patient’s Initials) _____ I DO CONSENT/ _____ I DO NOT CONSENT to the PHOTOGRAPHING or VIDEOTAPING the above referenced diagnostic test or procedure for medical, scientific or educational purposes, provided my identity is not revealed by descriptive texts accompanying the pictures. I understand that such photographing or videotaping may include other portions of my body as appropriate.

8. (Patient’s Initials) _____ I DO CONSENT/ _____ I DO NOT CONSENT to the possible presence of a SCIENTIFIC OBSERVER in the operating room during the above referenced diagnostic test or procedure should my physician make such a request. I understand that said observer is not in any way associated with Place of the People Ambulatory Center .

9. I have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of non-treatment, the procedures to be used and the risks and hazards involved and I believe that I have sufficient information to give this informed consent.

I certify this form has been fully explained to me, that I have read it or have had it read to me, that the blank spaces have been filled in, and that I understand its contents.

___________________________________ ________________________ 10410 Medical Lp. Unit 4B, Laredo, TX 78045Patient/Other Legally Responsible Person Witness Witness Address

I, Erik Sloman-Moll MD, have explained the risks, benefits and alternatives for this procedure to the patient and they understands.__________________________

.

Ultrasound Guided Biopsy(76942) «NameLastFirst» «DOB»

Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a US Guided Biopsy of a mm Right Left Neck Mass (784.2) Lymphadenopathy (785.6) Thyroid Nodule (241.0) Nodules (241.1) seen on previous films. US is requested to improve the accuracy and safety of a biopsy.Quality of Study: Excellent, sharp well defined structures and no motion artifact Good, well defined structures with little motion artifact Adequate, motion artifact limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusionsComparisons: Previous studies, but only reports are available: Previous Ultrasound of the neck done on _________ showes _______________ Previous CT films reviewed: Date:

RIGHT Thyroid Lobe : no nodules seen (60100:RTx )Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Thyroid ISTHMUS : no nodules seen (60100x )R L x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent R L x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent LEFT Thyroid Lobe : no nodules seen (60100:LTx )Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior-Mid-Inferior lobe x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent

RIGHT Neck : no mass seen (10021:RTx )Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent LEFT Neck : no mass seen (10021:LTx )Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Anterior Posterior Superior Inferior Parotid Jugular-Digastric Submandible Submental Posterior x x mm, microcalcifications, hyper vascularity, hypo-echogenic, serrous-sanguinous-purulent Rec: Follow up with the ordering doctor for discussion of results and further plans. Dictated:Transcribed:.

*«NameLastFirst» «DOB» Informacion y Consentimiento acerca de Procedimientos Medicos y Quirurgicos «Today» «Now»

PARA EL PACIENTE: Usted tiene el derecho a ser informado acerca de su condicion y de los procedimientos quirurgicos y medicos que se van a realizar. Al usted estar informado de los riesgos y peligros que existen, usted podra tomar la decision de autorizar que los procedimientos se realicen o no. Esta informacion no pretende asustarlo o alarmarlo; solamente queremos que usted este bien informado para dar o no su consentimiento a estos procedimientos.

1. Yo, voluntariamente autorizo y pido al Dr. Erik R. Sloman-Moll como mi medico, y a cualquier otro miembro o personal medico que mi doctor considere necesario, para el tratamiento de mi condicion medica la cual ha sido diagnosticada como: %

El Diagnostico secundario: El Asma (493. 9 0), Bronquitis Cronica (491.0), Hipertension (401.1), No Insulina Dependiente Diabetes Mellitus (250.00), Soplo cardiaco (785.2), Enfermedad de la Arteria Coronaria (414.00), Insuficencia renal cronica.

2. Yo, entiendo que los procedimientos medicos y quirurgicos se me van a realizar han sido planeados especificamente para mi, y yo acepto y autorizo voluntariamente que se me realicen los siguientes procedimientos:%

3. Yo intiendo de que si mi doctor descubre alguna u otra condicion, que se requiera diferent procedimiento del cual esta planiado. Yo autorizo a mi Dr. y acociados, assistentes tecnicos y algunos proveedores del cuidado de la salud, de actuar en cualquier procedimiento que se requiera segun su juicio profesional.

4. Yo certifico que no se me ha asegurado ninguna garantia de resultados o cura.

5. Asi como pueden existir riesgos y peligros si no recibo tratamiento, tambien existen riesgos y peligros si se me realizan los procedimientos medicos y quirurgicos que han sido disenados especialmente para mi. Yo me doy cuenta de que estos procedimientos tienen la posibilidad de causar infecciones (mayor oportunidad en pacientes con diabetes y/ o problemas de peso), coagulos sanguineos en mis pulmones y venas, hemorragias, reacciones alergicas y hasta la muerte. Estoy consciente de que los siguientes riesgos y peligros tambien pueden estar relacionados con la realizacion de estos procedimientos medicos y quirurgicos: Biopsy: bleeding, bruising, infection, pain, need for more invasive procedure

6. (Iniciales del Paciente)_____ Yo doy consentimiento _____ Yo niego consentimiento a Place of the People Ambulatory Center desechar cualquier tejido, parte del cuerpo y/o miembros obtenidos durante el procedimiento y/o examen referido anteriormente:___________________________

7. (Iniciales del Paciente)_____ Yo doy consentimiento _____ Yo niego consentimiento para que fotografien o filmen los procedimiento(s) o examene(s) referidos anteriormente para propositos medicos, educacionales o cientificos, provenido que mi identidad no es revelada por textos descriptivos que acompanan las fotos y/o filmes. Yo entiendo que tal fotografias y/o filmes pueden incluir otras partes de mi cuerpo si necesario.

8. (Iniciales del Paciente)_____ Yo doy consentimiento _____ Yo niego consentimiento a lo posible presencia de un observador cientifico en la sala de operacion durante el procedimiento o examen referido anteriormente, si me medico lo requisita. Yo entiendo que tal observador no esta de cualquier forma asociado con Place of the People Ambulatory Center.

9. Se me ha dado la oportunidad de hacer preguntas acerca de mi condicion medica, acerca de opciones o tratamientos alternativos, acerca de los riesgos que existen si no recibo tratamiento, asi como de los procedimientos que se van a realizar y los peligros y riesgos que estos procedimientos conllevan. Yo considero que he sido suficientemente informado para dar mi consentimiento.

Yo certifico que esta forma me ha sido explicada completamente, y certifico tambien que la he leido o he pedido que se me la lean, y que he llenado o he autorizado que me llenen los espacios en blanco que aqui se encuentran y certifico que entiendo todo su contenido.

___________________________________ _______________________ Suite 100, 7210 McPherson Blvd. Laredo TX 78041Firma del Paciente o Persona Responsable Testigo Direccion del Testigo

I, Erik Sloman-Moll MD, have explained the risks, benefits and alternatives for this procedure to the patient and they understands.__________________________

.

Ultrasound Carotid(93880) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a Carotid Doppler due to a right-left carotid bruit/thrill (R09.89), tinnitus (H91.1?), dizziness/vertigo (H89.9?), orthostatic hypotension (I95.1). US requested to evaluate for possible obstruction, turbulent blood flow and stenosisQuality of Study: Excellent, sharp well defined structures and no motion artifact Good, well defined structures with little motion artifact Adequate, motion artifact limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusionsComparisons: No previous films known Previous studies, but only reports are available: Previous Ultrasound of the neck done on _________ showes _______________ Previous CT films reviewed: Date: Findings: Neck Suprahyoid: Infrahyoid: Glands:

paraph. retroph. larynx hypo- supra- parotid sub- thoracic lymphspace space phary. glottis mand. inlet nodes

not seen R L R L R L R L R L R L R L R L R L normal R L R L R L R L R L R L R L R L R L abnormal R L R L R L R L R L R L R L R L R L

Thyroid: (Long) x (Anterior-Posterior) x (Transverse)Right: lobe is __x__x cm in size Left: lobe is __x__x cm in size

without focal lesions. without focal lesions.microcalcifications. microcalcifications.increased vascularity. increased vascularity.one: hyper-hypo-echo. cm sup-mid-inf pole. one: hyper-hypo-echo. cm sup-mid-inf pole.multiple: largest cm sup-mid-inf pole. multiple: largest cm sup-mid-inf pole.

Isthmus: without focal lesions.

Carotid Doppler:RCCA: [ ] / [ ] cm/s [No plaque | Wall thickening is present | Plaque causes < 50% narrowing of lumen diameter | Plaque causes at least 50% narrowing of lumen diameter | Near-occlusive plaque is present | Total occlusion; lumen not identified] [ ] RICA: [ ] / [ ] cm/s [No plaque | Wall thickening is present | Plaque causes < 50% narrowing of lumen diameter | Plaque causes at least 50% narrowing of lumen diameter | Near-occlusive plaque is present | Total occlusion; lumen not identified] [ ] RECA: [ ] cm/s [No plaque | Wall thickening is present | Plaque causes < 50% narrowing of lumen diameter | Plaque causes at least 50% narrowing of lumen diameter | Near-occlusive plaque is present | Total occlusion; lumen not identified] [ ] RVA: [ ] cm/s [Antegrade flow with normal waveform.]

LCCA: [ ] / [ ] cm/s [No plaque | Wall thickening is present | Plaque causes < 50% narrowing of lumen diameter | Plaque causes at least 50% narrowing of lumen diameter | Near-occlusive plaque is present | Total occlusion; lumen not identified] [ ] LICA: [ ] / [ ] cm/s [No plaque | Wall thickening is present | Plaque causes < 50% narrowing of lumen diameter | Plaque causes at least 50% narrowing of lumen diameter | Near-occlusive plaque is present | Total occlusion; lumen not identified] [ ] LECA: [ ] cm/s [No plaque | Wall thickening is present | Plaque causes < 50% narrowing of lumen diameter | Plaque causes at least 50% narrowing of lumen diameter | Near-occlusive plaque is present | Total occlusion; lumen not identified] [ ] LVA): [ ] cm/s [Antegrade flow with normal waveform.]

Bony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes (<3cm)

Impression: normal exam, no major abnormality. RIGHT: internal carotid artery: [Normal (no stenosis) | <50% stenosis | 50% to 69% stenosis | 70% stenosis to near occlusion | Near occlusion | Total occlusion]Vertebral arteries: [Antegrade flow with normal waveforms]Single-Multiple cysts-nodules, largest ____ cm. No change from ____ ultrasound.

LEFT: internal carotid artery: [Normal (no stenosis). | <50% stenosis | 50% to 69% stenosis | 70% stenosis to near occlusion | Near occlusion | Total occlusion] Vertebral arteries: [Antegrade flow with normal waveforms]Single-Multiple cysts-nodules, largest ____ cm. No change from ____ ultrasound.

Rec: Follow up with the ordering doctor for discussion of results and plans. Consider thyroid scan. Consider needle biopsy. Consider repeat Ultrasound in 3-6-12months. Dictated:

Ultrasound Neck(76536) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a US Neck right-left neck mass (784.2), right-left neck pain (723.1), oro-pharyngeal dysphagia (787.23). US requested to evaluate for possible inflammation, cysts or tumors.Technique: Gray scale ultrasound and color Doppler were utilized to evaluate the thyroid gland.Quality of Study: Excellent, sharp well defined structures and no motion artifact Good, well defined structures with little motion artifact Adequate, motion artifact limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusionsComparisons: No previous films known Previous studies, but only reports are available: Previous Ultrasound of the neck done on _________ showes _______________ Previous CT films reviewed: Date: Findings: Neck:RIGHT: Suprahyoid: Infrahyoid: Glands:

paraph. retroph. larynx hypo- supra- thyroid parotid sub- thoracic lymph vascularspace space phary. glottis mand. inlet nodes structures

not seen normal abnormal

LEFT: Suprahyoid: Infrahyoid: Glands: paraph. retroph. larynx hypo- supra- thyroid parotid sub- thoracic lymph vascularspace space phary. glottis mand. inlet nodes structures

not seen normal abnormal

Thyroid: (Long) x (Anterior-Posterior) x (Transverse)Right: The thyroid lobe is x x mm in size

without focal lesions. with microcalcifications.with increased vascularity.with one lesion, hyper-hypo-echogenic x x mm in the superior-mid-inferior pole.with multiple nodules, largest x x mm in the superior-mid-inferior pole.

Left: The thyroid lobe is x x mm in size without focal lesions.

Isthmus: is x x mm in size without focal lesions.

Bony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes (<3cm)

Impression: normal exam, no major abnormality.

No change from ____ ultrasound.

Rec: Follow up with the ordering doctor for discussion of results and plans. Consider thyroid scan. Consider needle biopsy. Consider repeat Ultrasound in 3-6-12months.ErikSloman-Moll. MDDictated:Transcribed:

Ultrasound Thyroid(76536) «NameLastFirst» «DOB»Order: «Today» «Now» «PhoneNumber» Ins.Call: Sched: Approv.#: Primary: «Ins1.CompanyName» «Ins1.Phone» «Ins1.Resp.FullName» «Ins1.PolicyID» Secondary: «Ins2.CompanyName» «Ins2.Phone» «Ins2.Resp.FullName» «Ins2.PolicyID» Tertiary: «Ins3.CompanyName» «Ins3.Phone» «Ins3.Resp.FullName» «Ins3.PolicyID» Clinical Indications: «Patient.Age» old «Sex» presents for a US Thyroid with a persistent thyroid goiter (E04.?), history of right-left thyroid nodule(s) (241.0 241.1). US requested to evaluate for possible inflammation, cysts or tumors.Technique: Gray scale ultrasound and color Doppler were utilized to evaluate the thyroid gland.Quality of Study: Excellent, sharp well defined structures and no motion artifact Good, well defined structures with little motion artifact Adequate, motion artifact limit the image, but the important landmarks can still be seen in the area of the symptoms Poor, motion artifact and positioning limit the usefulness of this study Distorted, motion artifact and positioning make it difficult to draw any conclusionsComparisons: No previous films known Previous studies, but only reports are available: Previous Ultrasound of the neck done on _________ showes _______________ Previous CT films reviewed: Date: Findings: Neck:RIGHT: Suprahyoid Infrahyoid Parotid Submandible Lymph nodes Vascularnot seen normal abnormal LEFT: Suprahyoid Infrahyoid Parotid Submandible Lymph nodes Vascularnot seen normal abnormal Thyroid: (Long) x (Anterior-Posterior) x (Transverse)

Right: The thyroid lobe is x x mm in size without focal lesions. with microcalcifications.with increased vascularity.with one lesion, hyper-hypo-echogenic x x mm in the superior-mid-inferior pole.with multiple nodules, largest x x mm in the superior-mid-inferior pole.

Left: The thyroid lobe is x x mm in size without focal lesions. with microcalcifications.with increased vascularity.with one lesion, hyper-hypo-echogenic x x mm in the superior-mid-inferior pole.with multiple nodules, largest x x mm in the superior-mid-inferior pole.

Isthmus: is x x mm in size without focal lesions.

Bony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes (<3cm)

Impression: normal exam, no major abnormality. Single right-left cyst-nodule ____ cm.Multiple right-left cysts-nodules, varing from ____ to ____ cm.No change from ____ ultrasound.

Rec: Follow up with the ordering doctor for discussion of results and plans. Consider thyroid scan. Consider needle biopsy. Consider repeat Ultrasound in 3-6-12months.ErikSloman-Moll. MD - electronic signatureDictated:Transcribed:

Dr.ErikDr. Erik R. Sloman-MollOtolaryngology, Head & Neck Surgery10410 Medical Loop, Unit 4BLaredo, Texas 78045-6672Phone (956) 794-8870 Fax (956) 795-8384Email: erik @ sloman-moll.com

«NameFirstLast» «DOB» DOS: «Today»

Radiology: CT Skull and Scalp not Brain (non-contrast) Iluma Cone Beam CT Scanner Xray taken by: Erik Sloman-Moll

Clinical Indications:

Technique: A safety questionnaire was completed and reviewed, the patient was positioned in the chair. The patient was positioned with the alignment laser as per scanning protocol. Marker placed over the Right Left skull frontal-temporal-parietal-occipital mass. A 40sec was performed. Computer generated axial, sagittal, coronal, and 3 dimensional images were displayed for interpretation. Quality: Adequate, low level of the radiation limit the image and ability to assess to the structures of the brain, but the important landmarks on the skull and scalp can still be seen in the area of the symptomsComparisons: No previous films knownFindings: Nasal Cavity: not seen Sinus: not seen

Brain: Extra-axial spaces: not seen Intracranial hemorrhage: not seen Ventricular system: not seen Basal cisterns: not seen Cerebral parenchyma: not seen Midline shift: not seen Cerebellum: not seen Brainstem: not seen Calvarium: normal Vascular system: not seen Visualized orbits: normal Upper cervical spine: not seen Sella: normalSkull base: Anterior: not seen well

Middle: normalPosterior: normal

T-bone: not seen wellSurface: skin contours normalBony landmarks: no fractures, no bone loss/erosion of skull

Impression: normal exam, no major abnormality.

Rec: Follow up with the ordering doctor for discussion of results and further plans. Consider higher energy CT or MRI Brain with Gadulinium to better assess the brain. Consider IV contrast to better visualize the vascular system. Consider further studies:

Film interpreted by: Erik Sloman-Moll, MD (signed electronically)Dictated: «Today» Transcribed: «Today» Reviewed: «Today»

Dr.ErikDr. Erik R. Sloman-MollOtolaryngology, Head & Neck Surgery10410 Medical Loop, Unit 4BLaredo, Texas 78045-6672Phone (956) 794-8870 Fax (956) 795-8384Email: erik @ sloman-moll.com

«NameFirstLast» DOB: «DOB» DOS: Iluma Cone Beam CT Scanner Xray taken by: Erik Sloman-Moll

Radiology: CT Neck (non-contrast) Clinical Indications:

Technique: A safety questionnaire was completed and reviewed, the patient was positioned in the chair. The patient was positioned with the alignment laser as per scanning protocol. A 40sec was performed. Computer generated axial, sagittal, coronal, and 3 dimensional images were displayed for interpretation. Quality of Study: Excellent, sharp well defined structures and no motion artifactComparisons: No previous films knownFindings: Nasal Cavity: RIGHT Septum: normal Inferior Turbinate: normalMiddle Turbinate: normalSinus: RIGHT Frontal Sinus: normalMaxillary Sinus: normalAnterior Ethmoid Sinus: normalPosterior Ethmoid Sinus: normalSphenoid Sinus: normalT-bone:RIGHT Middle Ear Cleft: normalTympanic Membrane: not seenOssicles: normalCochlea: normalVestibule: normalVestibular Aqueduct: not seen Cochlear Aqueduct: not seen Facial Nerve Canal: not seen Semicircular Canals: normalInternal Audtory Canal: normalExternal Auditory Canal: normalCarotid Canal: normalJugular Canal: normalTemporal Mandibular Joint: normalMastoid Aeration: Right normal Neck:RIGHT nasopharynx: normalSuprahyoid: oropharynx: normal

oral cavity: normalparapharyngeal space: normalretropharyngeal space: normal

Infrahyoid: larynx: not seen hypopharynx: not seen supraglottis: normal

Glands: thyroid: not seen parotid: normalsubmandibular: normal

thoracic inlet: not seen lymp nodes: normalvascular structures: normal

Nasal Cavity: LEFT Septum: normalInferior Turbinate: normalMiddle Turbinate: normalSinus: LEFT Frontal Sinus normalMaxillary Sinus: normalAnterior Ethmoid Sinus: normalPosterior Ethmoid Sinus: normalSphenoid Sinus: normalT-bone:LEFT Middle Ear Cleft: normalTympanic Membrane: not seen Ossicles: normalCochlea: normalVestibule: normalVestibular Aqueduct: not seen Cochlear Aqueduct: not seen Facial Nerve Canal: not seen Semicircular Canals: normalInternal Audtory Canal: normalExternal Auditory Canal: normalCarotid Canal: normalJugular Canal: normalTemporal Mandibular Joint normalMastoid Aeration: Left normal

*****************************************************************************************************************************************************************************************T-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ear and ossicles are normal, inner ears and orbits appear grossly normal.Face: Soft Tissue structures along the forehead, orbits, nose, maxilla and mandible are normal without subcutaneous air, fluid pockets or cysts or any masses. There is a mm by mm solid mass Mandible: Teeth are appropriate for age and appear to be in normoculssion. The forehead, nasal bones, orbital rims, maxilla and mandible show no sign of fractures. There is disruption TMJ: RIGHT: normal mild soft tissue calcification, normal mild loss of joint space, no mild erosion of condyleLEFT: normal mild soft tissue calcification, normal mild loss of joint space, no mild erosion of condyle**************************************************************************************************************************

Surface: skin contours normal, contours along the pharynx are normal Inner air-tissue surface: normal surface, nasal contours are grossly normal. Bony landmarks: no fractures, no bone loss/erosion of base of skull, vertebral bodies, normal styloid processes

Impression: normal exam, no major abnormality. RIGHT: mild moderate severe TMJ arthralgia, mild moderate severe septal deviation, mild moderate severe inferior turbinate hypertrophy, mild moderate severe conch bullosa, mild moderate severe maxillary retention cyst, stenotic maxillary-frontal-sphenoid ostium, polyps, mild moderate severe opacified acute chronic frontal sinusitis, mild moderate severe opacified acute chronic maxillary sinusitis, mild moderate severe opacified acute chronic anterior ethmoid sinusitis, mild moderate severe opacified acute chronic posterior ethmoid sinusitis, mild moderate severe opacified acute chronic sphenoid sinusitis, inspissated secretions suggesting fungal sinusitis,

mild moderate severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital retraction pocket attic antrum mastoid diffuse cholesteatoma, possible tympanic perforation, normal Internal Auditory Canal, LEFT: mild moderate severe TMJ arthralgia, mild moderate severe septal deviation, mild moderate severe inferior turbinate hypertrophy, mild moderate severe conch bullosa, mild moderate severe maxillary retention cyst, stenotic maxillary-frontal-sphenoid ostium, polyps, mild moderate severe opacified acute chronic frontal sinusitis, mild moderate severe opacified acute chronic maxillary sinusitis, mild moderate severe opacified acute chronic anterior ethmoid sinusitis, mild moderate severe opacified acute chronic posterior ethmoid sinusitis, mild moderate severe opacified acute chronic sphenoid sinusitis, inspissated secretions suggesting fungal sinusitis,

mild moderate severe chronic mastoiditis, bony erosion of scutum-ossicles-ear canal-mastoid-labyrhinth suggestive of a congenital retraction pocket attic antrum mastoid diffuse cholesteatoma, possible tympanic perforation, normal Internal Auditory Canal,

Rec: Follow up with the ordering doctor for discussion of results and further plans. Consider Ultrasound of lower Neck structure. Consider a CT with IV contrast to better evaluate vascular structures. Consider further studies:

Film interpreted by: Erik Sloman-Moll, MD (signed electronically)Dictated: Transcribed: Reviewed:

Dr.ErikDr. Erik R. Sloman-MollOtolaryngology, Head & Neck Surgery10410 Medical Loop, Unit 4BLaredo, Texas 78045-6672Phone (956) 794-8870 Fax (956) 795-8384Email: erik @ sloman-moll.com

«NameFirstLast» «DOB» DOS: «Today»

Radiology: CT Sinus (non-contrast) Iluma Cone Beam CT Scanner

Clinical Indications:

Technique: A safety questionnaire was completed and reviewed, the patient was positioned in the chair. The patient was positioned with the alignment laser as per scanning protocol. A 40sec was performed. Computer generated axial, sagittal, coronal, and 3 dimensional images were displayed for interpretation. Quality of Study: Excellent, sharp well defined structures and no motion artifactComparisons: No previous films knownFindings: Nasal Cavity: RIGHT Septum: normal Inferior Turbinate: normalMiddle Turbinate: normalSinus: RIGHT Frontal Sinus: normalMaxillary Sinus: normalAnterior Ethmoid Sinus: normalPosterior Ethmoid Sinus: normalSphenoid Sinus: normalT-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ear and ossicles are normal, inner ears and orbits appear grossly normal.

Nasal Cavity: LEFT Septum: normalInferior Turbinate: normalMiddle Turbinate: normalSinus: LEFT Frontal Sinu: normalMaxillary Sinus: normalAnterior Ethmoid Sinus: normalPosterior Ethmoid Sinus: normalSphenoid Sinus: normalT-bone: Portions in the field of view are normal. Mastoids are well aerated, middle ear and ossicles are normal, inner ears and orbits appear grossly normal.

Surface: skin contours are normal Inner air-tissue surface: normal surface, nasal and pharyngeal contours are grossly normal. Bony landmarks: no fractures, no bone loss/erosion, no bone overgrowth.

Impression: normal exam, no major abnormality.

Rec: Follow up with the ordering doctor for discussion of results and further plans.

Film interpreted by: Erik Sloman-Moll, MD (signed electronically)Dictated: «Today» Transcribed: «Today» Reviewed: «Today»

Page 2

Dr.ErikDr. Erik R. Sloman-MollOtolaryngology, Head & Neck Surgery10410 Medical Loop, Unit 4BLaredo, Texas 78045-6672Phone (956) 794-8870 Fax (956) 795-8384Email: erik @ sloman-moll.com

«NameFirstLast» «DOB» DOS: «Today» Iluma Cone Beam CT Scanner

Radiology: CT Temporal Bone (non-contrast) Clinical Indications:

Technique: A safety questionnaire was completed and reviewed, the patient was positioned in the chair. The patient was positioned with the alignment laser as per scanning protocol. A 40sec was performed. Computer generated axial, sagittal, coronal, and 3 dimensional images were displayed for interpretation. Quality of Study: Excellent, sharp well defined structures and no motion artifactComparisons: No previous films knownFindings: Nasal Cavity: RIGHT Septum: normal Inferior Turbinate: normalMiddle Turbinate: normalSinus: RIGHT Frontal Sinus: normalMaxillary Sinus: normalAnterior Ethmoid Sinus: normalPosterior Ethmoid Sinus: normalSphenoid Sinus: normalT-bone: RIGHT Middle Ear Cleft: normalTympanic Membrane: not seenOssicles: normalCochlea: normalVestibule: normalVestibular Aqueduct: not seen Cochlear Aqueduct: not seen Facial Nerve Canal: not seen Semicircular Canals: normalInternal Audtory Canal: normalExternal Auditory Canal: normalCarotid Canal: normalJugular Canal: normalTemporal Mandibular Joint: normalMastoid Aeration: normal

Nasal Cavity: LEFT Septum: normalInferior Turbinate: normalMiddle Turbinate: normalSinus: LEFT Frontal Sinus: normalMaxillary Sinus: normalAnterior Ethmoid Sinus: normalPosterior Ethmoid Sinus: normalSphenoid Sinus: normalT-bone:LEFT Middle Ear Cleft: normalTympanic Membrane: not seenOssicles: normalCochlea: normalVestibule: normalVestibular Aqueduct: not seen Cochlear Aqueduct: not seen Facial Nerve Canal: not seen Semicircular Canals: normalInternal Audtory Canal: normalExternal Auditory Canal: normalCarotid Canal: normalJugular Canal: normalTemporal Mandibular Joint: normalMastoid Aeration: normal

Surface: skin contours along head and auricles are normal Inner air-tissue surface: normal surface, nasal and pharyngeal contours are grossly normal. Bony landmarks: no fractures, no bone loss/erosion, scutums and ossciles are intact, no bone overgrowth.

Impression: normal exam, no major abnormality.

Rec: Follow up with the ordering doctor for discussion of results and further plans. Consider MRI of the IAC with Gadulinium to better assess a possible acoustic neuroma.

Film interpreted by: Erik Sloman-Moll, MD (signed electronically)Dictated: «Today» Transcribed: «Today» Reviewed: «Today»

Page 2

«NameLastFirst» «DOB» OBSTRUCTIVE SLEEP APNEA WORK SHEET «Today» «Now» Tonsillar Hypertrophy Grade Larynx Axial View Mandell Grade

Sagital View Nasal Axial View Adenoid Hypertrophy % obstruction Right Gerlach Tonsil Hypertrophy Left Gerlach Tonsil Hypertrophy Septal Bone % obstruction Right

% obstruction Left Septal Cartilage % obstruction Right

% obstruction Left Septal Bone Spur % obstruction Right

% obstruction Left Inferior Turbinate % obstruction Right

% obstruction Left Middle Turbinate % obstruction Right

% obstruction Left Quadrangle Cartilage Tip Hypertrophy to Right Quadrangle Cartilage Tip Hypertrophy to Left Columellar Obstruction width mm Right Nasal Valve Collapse Left Nasal Valve Collapse

Nasal Coronal View Nostril Stenosis Grade Work Up: Sleep Assessment score:CBC/CMP: WNL TFTs: WNL CXR: WNL PFTs: FEV1: % of predict CT Sinus: WNL CT Neck: No new findings

Plan 0: Weight reduction/Decongestants/Nasal Steroid/Antihistamines/Luekotriene Inhibitors, BroncodialatorsPlan 1: Sleep study and possible CPAP Trial, if failure proceed to Plan 2Plan 2: Surgery; Stage 1, 2 & 3, then repeat Sleep study before considering Stage 4, 5 & 6Stage 1 Rhino with: Thin Columellar NSR Tip reduction Spreader Grafts

Turbinate reductionStage 2 T&A with: Gerlach tonsil Right Concha Bullosa Left Concha BullosaStage 3 UPPP with: Right Valvepexy Left Valvepexy Radioablation Stage 4

Notching TVC Glossopexy Hyoid advancementStage 5 Trach Stage 6 "Tubeless Trach" 2nd stage