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SAINT ALPHONSUS – MOBILE MAMMOGRAPHY UNIT
PATIENT SCHEDULE
FACILITY:
CONTACT PERSON:
DATE OF SERVICE:
PHONE:
TIME BD/MAMMO PATIENT NAME BIRTH DATE PHONE
9:00
9:15
9:30
10:00
10:30
10:45
11:00
11:15
11:30
12:30
12:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
Fax schedule to: Attn: MHSU at (208) 367-7763 4-5 days prior to service date.
Please note:
• No lapse in time between patients.
• We CAN’T do mammograms on patients under the age of 35 without doctor’s order.
• We recommend annual mammograms starting at age 40.
• Must have 15 women scheduled.
• We have grants available for women between the ages
of 35 and 64 who do not have insurance.
• Please bring your insurance card and driver’s license.
If you have questions, please call 367-3571.