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AMIC Radiology STAT Call Form
Published: 12/14/2023
All Items Must be Completed

Patient Name (Last, First) ,
Exam Description  
Call Report To Name:  
Call Report to Phone#:  
Call Required
Stroke Alert  or

 These fields will only be enabled if the requesting site has patient waiting enabled.
Is the patient waiting
Patient Location  
Please do not enter the patient's personal phone number in this field. 
Patient Location Phone  

For use only during a EPIC downtime.
****** Please indicate if this a STAT exam ******
 Contrast Amount in ML:   Contrast Type:

  Please be patient after hitting Submit
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