{"text":"GL.ASGOW ROYAL INFIRMARY \n&@&AB oop\u2018\/ . . \nPERIPHERAL VASCULAR SURGERY o \nRequest for Vascular Laboratory Tests: Immmummmm\ufb01mmmw \n. 10338654X \nPATIENT'S NAME CLELIAND P \nOut Patient\/Inpatient Ward \\ ;tgnigmm conD 08\/09\/1955 i \n. KILSYTH . \nDo you require: . GLASGOW Ges 9pg i \n: PRS0 LameL L \nDOPPLER: Static ABPI Does patient have oPL \nPost-exercise ABPI . ' Y N : \nSP2 Toe pressures , 1) Angina K A \nOTHER: 2) Diabetes N \nCLINICAL INDICATIONS FOR TEST: . PRESENTATION: \n1) Diagnostic Problem 1) Pain of uncertain origin | \n2) Pre-opbaseline ' , : 2) . Intermittent Claudication \n3) Followup 3) Rest pain ' \n4) Other 4) Necrosis \u2014 toes\/foot \n5) Other \nPrevious vascular procedures: ' \nO Please indicate pulses (ring for bruit) \nPULSE AORTA FEM POP P.TIB ATIB \n- RIGHT \u00bb \nDR MAKING REQUEST LEFT \nRESULTS \nStatic pressures: Post-operative static pressures \nRIGHT LEFT OPERATION \nBrachial \nAnt. tibal DATE: \nPost.tibial Post-Op Day: \n. Ratio ost-Up Day: - Date: \nC \\ SP2Toe \nL Y \nRatio A . RIGHT LEFT \n. \u2018 : Brachial \nWalking Distance (at2kph, Ant. ibial \no Post. tibial \n10% inclination) . \nRatio \nDistance to pain \nWalking distance A D \nPost-exercise pressures: Post-Op Day: Date: \nRIGHT RIGHT LEFT \n\" Brachial Brachial \nAnt. tibial Ant. tibial \nPost. tibial Post. tibial \nRatio Ratio \nCOMMENTS C\\ o \n~ Ao t\\sa. \\o\\Yg-g\\ \\o\\.ue.-\\_a_ \noo ta ?6\\'\\ \nSQIRNSTLIRE 2 L NfDe oy \ne PATEACSTCOT. \n'\\._:.-\\;\\ \\ - - A 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