MAMMOGRAM APPOINTMENT AND RESULT NOTES
Purpose: Prepare for imaging and record the follow-up plan with your care team.
This editable record is private; keep it securely. It does not interpret results.
Guide and sources: https://yenra.com/digital-mammography/
Updated October 9, 2026.

Appointment date / facility / contact:
Reason: screening / breast change / follow-up finding:
Change or concern to report / when it started:
Previous imaging facility / date / transfer arranged:
Implants, surgery, pregnancy possibility or positioning needs to discuss:
Facility preparation instructions:

Date results expected / how they will arrive:
Who explains the results / contact if delayed:
Exact BI-RADS assessment from report:
Density wording from report:
Recommended next test or appointment / date:
Who arranges it:
Questions about the recommendation:
Plan for a persistent or new breast change:

Report new or persistent changes to your clinician even after a reassuring
mammogram. Use the team's actual follow-up recommendation and timing.