Sample, Sammy G ST0001

PET Evaluation Form 1234567890


MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
List any nodule(s) of concern* in the table below. If baseline >= 6 mm or if repeat, >= 3 mm
Enter the Nodule Uptake values and update the Nodule Status to reflect the results of the PET study, and update the neccesary actions for each nodule, as indicated. Enter any details given in the PET report in the PET Details field.
Update the Follow-up section.
Nodule ID Nodule 1 Additional Nodules

Follow Up

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Impression