59MDWI44-116 — Wilford Hall Ambultory Surgical Center Cardiac Imaging Intake

59MDWI44-116 governs the completion and submission of the 59th Medical Wing Form 17 for cardiac imaging intake.

Search 59MDWI44-116

  • Publication number: 59MDWI44-116
  • Title: WILFORD HALL AMBULTORY SURGICAL CENTER CARDIAC IMAGING INTAKE
  • Date: 2021-05-04

View 59MDWI44-116 on armypubs.army.mil


The publication covers screening assessments for patients scheduled for Computed Tomography Angiography and Coronary Artery Calcium Score procedures. It requires designated personnel to provide and accurately complete the form, then submit it for upload into the electronic medical record.

Applies to: This instruction applies to all personnel assigned, attached or under contract to the 59th Medical Wing.

Topics covered

  • Cardiac imaging intake
  • Screening assessments
  • Computed Tomography Angiography
  • Coronary Artery Calcium Score
  • 59 MDW Form 17 completion
  • Electronic medical record submission

Questions and answers

What is the purpose of 59 MDW Form 17?

The purpose of 59 MDW Form 17 is to document screening assessments on patients scheduled for a Computed Tomography Angiography and Coronary Artery Calcium Score procedure. (paragraph 1)

Who must receive 59 MDW Form 17?

The physicians, registered nurses, licensed vocational nurses, medical technicians, and administrative clerks ensure that all patients scheduled for a Computed Tomography Angiography and Coronary Artery Calcium Score receive 59 MDW Form 17 to complete on arrival.

Who is responsible for ensuring that 59 MDW Form 17 is complete and accurate?

The physician, registered and/or licensed vocational nurses, medical technician, and clerk personnel are responsible to ensure 59 MDW Form 17 is filled out completely and accurately.

Where is 59 MDW Form 17 submitted?

59 MDW Form 17 is submitted to the Cardiology Clinic or Radiology Department staff and uploaded into the electronic medical record upon completion of the encounter. (paragraph 3)

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