Welcome to the Memorial Outpatient Services Guide. Physician offices may download and print the patient procedure order forms below. All of the pages are in PDF format; you will need Adobe Acrobat to open them. Click here to download Acrobat for free.

If you have any questions about the Memorial Outpatient Services Guide, please call Memorial Physician Relations at (574) 647-6801.

Rehabilitation/Therapy

Memorial's Outpatient Therapy Services can serve any of the following needs

• Physical Therapy • Hand Therapy

• Occupational Therapy • Functional Capacity Evaluation

• Speech/Language Pathology • Work Hardening/Conditioning

• Brain Injury Program • Back School

• Neuropsychological Services • Pelvic Floor/Incontinence Program

• Driver evaluation • Lymphedema Program

To schedule appointments, please call (574) 647-2600, or fax order to (574) 239-6460
Memorial Outpatient Therapy Services

Breast Care Services

To schedule appointments, please call 647-6850, or fax order to 647-1818
Breast Care Order Sheet

Diagnostic Radiology Services

To schedule an appointment, please call Centralized Scheduling at 647-7700. FAX ORDERS TO 647-3652.

Angioplasties

All

Embolization

Infusion for thrombosis (TPA)

Arteriograms

Aortogram

Aortic Arch and Carotid DSA

Cerebral Arteriogram

Renal DSA

Aortogram w/Lower Extremity Angio (run-off)

Other

Arthrograms

Facet Injection

Hip Bursa Injection

Hip Aspiration

Intra Articular Injection

Arthrogram (specify joint)

Biopsy

Bone

Liver

Lung

Lymph Node

Renal

Other

Catheter Drainage

Abcess

Biliary

Gallbladder

Nephrostomy

Other

Catheter Placement

Apheresis Cath

Groshong Cath

Other

Celiac Plexus Neurolysis Sympathectomy

CT Scans

Ct Scan-Angiography
CT Scan-Extremities

Cervical Spine

LS Spine

Thoracic Spine

Extremity-Specific

CT Scan-Internal

Sedation CT

Biopsy with Outside Physician

Liver Portagraphy

CT Scan-Neck Up

Brain

Facial Bones

Mandible

Temporal Bone

Orbits

Neck

Sinuses

Stealth Sinuses

CT Scan-Trunk

Abdomen

Abdomen & Pelvis

Chest

Pelvis

Diagnostic

Abdomen
Chest
Extremities
Generic
Spine
Fistulagram

Fistulagram Vein, Vessel, Artery (dialysis)

Venous Fistulagram

Gastrostomy Tube Check

Gastrointestinal Studies

ERCP
Gallbladder (oral cholecystogram)
GI Radiology

Diaphragm Fluoroscopy

GI Fistulagram

Pouchogram

GI Study

Enteroclysis

Esophagus (Barium Swallow)

Function Swallowing Study

Small Bowel Only

Upper GI

Upper GI w/Air Contrast

Upper GI w/Air Contrast & Small Bowel Follow-through

Upper GI & Small Bowel

Lower GI Study

Barium Enema (Colon Study)

Barium Enema w/Air Contrast

Genitourinary Studies

Hysterosalpingogram (HSG)
GU- IVP/Cysto

Cystogram

Intravenous Pyelogram (IVP)

Loopogram

Retrograde Cyptogram

Voiding Cystourethrogram

Tomograms

Extremity

Kidney

Other

Interventional Radiology Consult

Liver- Diagnostic Biliary Endoscopy

Myelograms

Cervical Myelogram w/CT(combo) Lumbar Myelogram w/CT(combo)

Thoracic Myelogram w/CT(combo)

Methotrexate Injection (intrathecal)

Entire Spinal Canal Myelogram w/CT

Discogram

Discectomy

Lumbar Puncture

Neural Foraminal Injections

Cervical w/Contrast (combo)

Lumbar w/o Contrast (combo)

Thoracic w/o Contrast (combo)

Nuclear Medicine

Bone Scan
Gallium Scan
Gastric Emptying
Special & Sedation
GE Reflux
HIDA Scan
Indium WBC Scan
Liver/Spleen Scan
Meckel's Scan
MUGA Scan (Resting-Ventriculogram)
Node Imaging

Sentinal Node Imaging (Breast)

Melanoma-Sentinal Node Imaging

Radionuclide Cisternography (injection)
Renal Scan

Flow and Function

Possible Obstruction

Renovascular Hypertension

Thyroid Scan
VQ Lung Scan
Whole Body and PET Scan

Selective Fallopian Tube Recanalization

Sialogram

Thoracentesis/Paracentesis

T.I.P.S.

Combo

Revision

Ultrasound

Abdomen

Abdomen LTD (RUQ) (Liver, GB, pancreas, kidneys)

Aorta

Complete Abdomen

Renal

Carotid

Carotid Doppler

Transcranial Doppler

Extremities/Arteries

Extremity US, not DVT

Groin US- pseudo aneurysm

Sapheno Femoral JNCT US

Venous Doppler Bilateral

Venous Doppler Unilateral

Infant

Infant Hip US

Neonatal Head US

OB/GYN

Biophysical Profile Only

Follicle Study

OB US

OB & Biophysical Profile

Pelvic US

Pelvic/Transvaginal US

Sonohysterogram

Prostate/Testicular

Prostate Biopsy

Prostate US

Testicular

Thyroid

Neck US

Thyroid Biopsy

Thyroid US

Vascular Lab

Ankle Brachial Index

Arterial Flow Study (doppler)

Other

Vascular- Transcutaneous Oxy. Measure

Trans. Oxy. Measure/ABI

Trans. Oxy. Measure/ AFS

Venogram

Vertebroplasty

Cardiology Services

Adenosine Sestamibi
Cardiac Catheterization
Dobutamine Echo Stress
Dobutamine Sestamibi
Echocardiogram
Electrophysiology Studies
Nuclear Stress Test
Radio Frequency Ablation

PTCA

DCA

Rotoblator

Laser Angioplasty

Sestamibi Treadmill
Stress Echocardiogram
Tilt Studies
Transesophageal Echocardiogram
Treadmill Stress Test

Neurodiagnostic Services

Evoked Responses

Ver. Ser. Baer Combination

Visual Evoked Response

Somatosensory Evoked Response

Somatosensory (SER) For Surgery

Brainstem Evoked Response/Tympanogram

EEG - w/prep

Electroencephalogram (90 min.)

48 hour Ambulatory- Initial

48 hour Ambulatory 24hr. F/U visit

48 hour Ambulatory 48hr. F/U visit

EEG video

24 hour Ambulatory- Initial

24 hour Ambulatory F/U visit

EMG

EMG 30 min All Diagnoses

EMG 45 min. (Except Bilat Lower Extremity)

EMG Bilateral Lower ExtremityNerve Conduction Velocity Study

Outpatient Infusion Services

To schedule an appointment, please call 647-6545.

IV FLUIDS

IV Fluids (4-8hr.)

Solumedrol Injection

Epogen/Infed

IV Antibiotic

IV Antibiotic Elderly

IVIG

Epogen Injection

IM Injection

PICC

PICC Insertion

PICC Maintenance

Synchromed

PICC Insertion/Antibiotic

Pulmonary Services

Please see individual sheets for phone number for scheduling.

Bronchoscopy
Generic Prep Sheet
Hyperbaric Treatments
Methacholine Challenge Study
Pulmonary Function Tests

Exercise Desaturation

O2 Saturation

Sleep Study

Polysomnogram

CPAP Titration

Multiple Sleep Latency Test

Respiratory Treatments