Clinical Worksheets
Radiology Clinical Worksheets
EviCore.com recently upgraded and some of your bookmarked worksheets might have changed. Please ensure you are navigating to our most recent EviCore Worksheets.
Search by health plan name to view clinical worksheets. Adobe PDF Reader is required to view clinical worksheets documents
If you would like to view all EviCore core worksheets, please type "EviCore by Evernorth" into your health plan.
CT Scans
MRI
- CTA and MRA - Head
- MRA and CTA - Head and Neck
- MRI - Abdomen
- MRI - Abdomen and Pelvis
- MRI - Breast
- MRI - Knee
- MRI - LE and UE Joint
- MRI and CT - Head
- MRI and CT - Head and CT Neck
- MRI and CT - Head and MRI Spine
- MRI Spine - Evaluate Back or Neck Pain
- MRI Spine - Multiple Sclerosis
- MRI Spine - Trauma
PET Scans
- PET Scan Fax Request Form
- PET-CT - Breast Cancer
- PET-CT - Cervical Cancer
- PET-CT - Colon Cancer
- PET-CT - Esophageal Cancer
- PET-CT - Head and Neck Cancer
- PET-CT - Lung Cancer
- PET-CT - Lymphoma
- PET-CT - Melanoma (Skin) Cancer
- PET-CT - Other Cancer
- PET-CT - Ovarian Cancer
- PET-CT - Pancreatic Cancer
- PET-CT - Prostate Cancer
- PET-CT - Solitary Pulmonary Nodule
Ultrasound
- Ultrasound - Abdominal Vascular
- Ultrasound - Bone Density
- Ultrasound - Breast
- Ultrasound - Carotid
- Ultrasound - Chest Mediastinum
- Ultrasound - Duplex Scan of Penile Vessels
- Ultrasound - Echoencephalography
- Ultrasound - Extracranial Artery
- Ultrasound - Extremity Artery
- Ultrasound - Extremity Nonvascular
- Ultrasound - Extremity Venous
- Ultrasound - Female Pelvic
- Ultrasound - Infant Hips
- Ultrasound - Kidney Transplant
- Ultrasound - Male Pelvic
- Ultrasound - Multiple Pregnancies
- Ultrasound - Neck (Nonvascular)
- Ultrasound - Opthalmic
- Ultrasound - Retroperitoneum
- Ultrasound - Screening for Abdominal Aortic Aneurysm
- Ultrasound - Sonohysterography
- Ultrasound - Spinal
- Ultrasound - Transcranial Doppler
- Ultrasound - Transrectal Prostate Volume
- Ultrasound - Unlisted CPT Code