ࡱ> Y[Xg <bjbjXX 4>2\2\ >>>>>RRRR,~lR8.llll[[[7777777$:=Z8Q>[[[[[8>>llp8ccc[.>l>l7c[7ccRq4Q7l)"De578085==<Q7=>Q7[[c[[[[[88c[[[8[[[[=[[[[[[[[[> : Request for St. Louis Childrens Hospital Radiology Testing Availability To request testing availability for Radiology research tests, please fill in all applicable fields. Availability is based on CPT codes provided below and reflect the routine time and activities required when that clinical CPT code is billed. Pricing is provided by St. Louis Childrens Hospital Finance Department Please complete the form labeled Pricing Request for St. Louis Childrens Hospital Clinical Study on the CCS Website. Pricing is based on the CPT code, please note if the patient will require sedation. Date of Request: PI Name: Requester Name: PI Email: Requester Email: Requester Phone: IRB #: Protocol ID #: Sedation necessary: Professional Reading Required: (note: all images will be available in Clinical Desktop) Radiology: Procedure * (Nuc Med, US, IR and MRI require approval)CPT Code(s)MRI Scanner Required Location MRI 1, MRI 2, MRI 3* For Radiology protocols outside the normal scope of the CPT Code, please check the Radiology area and submit with the Imaging Acquisition Guidelines (IAG) to contacts below. & MRI: & CT: & US: Dan Huellewig Anne Klepner Stacey Reime  HYPERLINK "mailto:daniel.huellewig@bjc.org" daniel.huellewig@bjc.org  HYPERLINK "mailto:anne.klepner@bjc.org" anne.klepner@bjc.org  HYPERLINK "mailto:stacey.reime@bjc.org" stacey.reime@bjc.org & Nuclear Medicine: & Interventional Radiology: & General Radiography Kristine Hellige Anne   )HIil; < =  + Q R * I g i    ! * , P üݰݫݦݞх݅~ytld\hF $h^j5hF $h^ 5hF $hO55 hO55 hC5 hqmhz] h*5h*h h^jhMrhz]hqmCJaJ h=5 hz]5hN4hO55h= hN4h^j hN4hz] hN4h_hqmhN4h=5 hqm5hN4h^j5 h|5hN4hMr5hN4hz]5$I= R r  ! 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