Niount Sinai Heart Cardiovascular Imaging Center 1428 Madison Avenue • New York, NY • 10024 Phone: 212-241-3000 • Fax: 646-537-9693 Name: Epstein, Jeffrey Scan Date: 09/06/2016 MRN: Acc Number: DOB: 01/20/1953 Ref erringMD: Rony Shimony, MD Age/Gender: 63/M Att endingMD: Adam Jacobi , MD Summary CT without contrast was performed for coronary calcium, chest, abdomen and pelvis evaluation. Reconstructions were transferred to a workstation for further analysis. 1. Coronary atherosclerosis without significant stenosis. 2. The calcium score is 63 (53rd percentile adjusted for age. gender and ethnicity). 3. Normal left ventricular size and systolic function. No regional wall motion abnormalities. 4. No abdominal aortic or iliac arterial aneurysm. Scan Info General Contrast Agent Medication Administered During Scan Type: None Type: Metoprolol IV, NTG SL 0.4mg Dose: 85 ml Metoprolol IV, Dose: 10 mg Vital Height: 72 in Height: 182.9 cm Body Weight: 190 lbs Body Weight: 86.2 kg BSA: 2.1 rn^2 Heart Rate: 71 8PM Heart Rhythm: Sinus Rhythm Setup Type: Clinical Location: Outpatient ECG Gating Technique: Prospective Study Quality: Good Referring Provider: Rony Shimony, MD Attending Radiologist: Adam Jacobi , MD Attending Cardiologist: Gina LaRocca, MD Billing CPT Code(S) 71275, 74174 CTA Chest, ABD/Pelvis w/wo Contrast 75574. 71275 CTA Coronary & Chest w/wo Contrast ICD-10 Code (5) Miscellaneous Z13.6 Encounter for screening for cardiovascular disorders Finalized and signed by Adam Jacobi on 09/06/2016 13:57:56 (uid:180) Page 1 of 5 EFTA00298077