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Get Baylor University Medical Center 3500 Gaston Avenue, 1st Floor Roberts Hospital, Dallas, Texas 75246

Diseases CT: Computed Tomography Received Order by the Scheduling Department: Date: / / Time: : BAYLOR UNIVERSITY MEDICAL CENTER DALLAS, TEXAS 50476 (Rev. 04/10) SCHEDULING REQUEST AND ORDER FORM Test Preparations Baylor University Medical Center at Dallas X-Ray CT/CTA MRI/MRA Ultrasound: Routine and Vascular Digital Fluoroscopy Diagnostic XRay Nuclear Medicine UPPER GI AND/OR SMALL BOWEL: Do not eat, drink, smoke, or chew gum after mid.

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