Vimago Request Form Instructions
Instructions for Completing the Vimago HDVI/Fluoroscopy Scan Request Form for Referring Veterinarians
SECTION I- Vimago Scan Requested:
Please consult the Vimago HDVI Scan Guide to determine which scan is needed. Please feel free to call CareFirst Animal Hospital at Oberlin to discuss the case with one of our veterinarians or Vimago trained Customer Service Technicians to help determine which scan area is needed. Please include your diagnosis/rule outs for the current problem so that we can provide the most comprehensive scan possible.
SECTION II– Referring Veterinarian Information:
Please complete this section in full. If we have questions about your patient, questions in regards to the scan request, or need to contact you during the scan it is important that we have complete contact information. Please ensure that you or an associate familiar with the case is available the day the scan is being performed.
SECTION III- Diagnostic report:
A written diagnostic report will be sent via email as soon as we receive the written report from the Board Certified Radiologist. This is usually within 48-72 hours, but can be expedited to 24 hours for an extra charge of $100.
SECTION IV- Patient Information:
- Owner contact information: Please complete this section in full. This will allow us to setup a client/patient account prior to the patient’s appointment.
- Patient information: Please provide as much information as possible. This ensures that we can properly prepare for your patient’s sedation/general anesthesia.
- ARC Status: Please assign an Anesthetic Risk Classification (ARC) to the patient using the table below. This classification will help determine what laboratory tests will be required prior to the appointment and will help us in preparing for your patient’s sedation/general anesthesia. Bloodwork should be performed no more than 30 days prior to the scan/appointment. ARC score of 3 or higher should have bloodwork within 7 days of the scan appointment.
Anesthetic Risk Classification (ARC)
|1: Excellent||Apparently healthy, no obvious signs of disease||Hip dysplasia, OCD lesions, Dental disease|
|2: Good||Mild systemic disease Neonatal patient <8 weeksGeriatric patient >10 years||Epistaxis, Bulla abnormalities, Uncomplicated IVDD, CCL rupture, etc|
|3: Fair||Moderate systemic disease||Fever, Anemia, Chronic heart disease, Anorexia, Weight loss, Diaphragmatic hernia, Pneumothorax, Dehydration, Controlled seizures, Renal disease, Controlled diabetes, etc.|
|4: Poor||Severe systemic disease that is a constant threat to life||Shock, Uremia, Severe anemia, Uncontrolled diabetes, DIC, Severe dehydration, High fever, Sepsis, GDV, Severe pulmonary disease, Decompensated heart or renal disease|
|5: Guarded||Moribund patient||Multisystem organ failure, Severe head injury, Profound shock, Trauma|
|E: Emergency||Emergency situation added to ARC 1,2,3,4,5|
*The veterinarians at CareFirst Animal Hospital at Oberlin reserve the right to decline any Vimago imaging requests for patients of ARC 4 and higher.
SECTION V- Request/Additional Comments:
Please complete this section if you have any special request or concerns.