DTF Submission Template:  Last Revised July 15, 2005 – BOOKMARK THIS PAGE.
Do CTRL-A  (Select ALL)  --- CTRL-C (Copy) --- Then paste into your word processor

Rotation Number: 

Patient name: 

Patient MRN:  

Your full name: 

Attending radiologist: 

Hospital name: 

Clinical History: 

Image info for looking up / pulling images: 

Findings: 

Differential Diagnosis:

• DDx1
• DDx2
• DDx3
• DDx4
• (4-5 or more)

Actual diagnosis: 

Informational & Key points: 

• Point
• Point
• Point
• Point
• Point
• Point
• Point
• (8 or more)

References: 

Any instructions or suggestions regarding case flow: 

Any special info for the Production Assistant: 

Acknowledged online?:  

Auntminnie competition and/or your personal preference (just trash this section if not interested):    If you choose to write a discussion in place of the "Informational & Key" bullet points, please arrange the discussion into the following 3 sections.  (Note that the items below only supplant the "Informational & Key" bullet points; everything else above is still required).  All items below in total should not be more than a page long:

Discussion of Disease:

Radiologic Overview of the Diagnosis:

Key points:

• Key point 1
•   ...
• Key point 4 or more