Stroke CODE CT Head, Non-con Only (STAT) 
Stroke - Basic Head CT 
STROKE CODE- CT HEAD W/ O IV CONTRAST
ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Stroke
What specific question(s) would you like answered by
this exam? Stroke
Relevant recent/past history? Stroke
Is patient pregnant?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Last patient weight? (will auto pull in value and date in
Transport Method: Floor Determined/Entered
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org