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SCREENING FORM MammogramPap Test Screening Results Michigancancer
Performed Declined R L Mammogram Results/ Follow-up Facility Ultrasound Results Not Indicated Omitted ACR 1 - Negative None ACR 2 - Benign Finding None/Short-term 3 months ACR 3 Probably Benign ACR 4 Suspicious Abnormality ACR 5 Highly Suggestive of Malignancy Immediate 1-2 months ACR 0 Additional Work-up Required ACR 0 Assessment Inc. - Film Comparison Ordered Date Comparison Films Obtained // Final Mammogram Result R breast L Breast Additional Work-up Required Specify FOLLOW-UP PROCEDURES...Show details
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