Electrodiagnostic Study Interpretation Report (EMG/NCS)

Electrodiagnostic Study Interpretation Report (EMG/NCS)

(Tables are required for NCS and needle EMG results—do not convert to narrative. Abnormal values must be explicitly flagged. Temperature must always be documented. If information is unavailable for required fields, enter "Not available" rather than omitting. The impression must provide a clear diagnostic synthesis, not merely restate findings.)

Patient Information

Patient Name: [Full name]

MRN: [Medical record number]

Date of Birth: [MM/DD/YYYY]

Sex: [Male / Female / Other / Not available]

Height: [Height with units]

Weight: [Weight with units]

Date of Study: [MM/DD/YYYY]

Facility: [Facility name]

Referring Clinician: [Name, credentials]

Interpreting Physician: [Name, credentials]

Indication

[Clinical question prompting study and target of evaluation] [Relevant symptoms and/or exam findings supporting medical necessity] [Laterality and distribution] (State the specific clinical question rather than a billing diagnosis. If referral is vague, explicitly note the limitation and describe how the study was targeted based on patient-reported symptoms and focused exam. Limit to one to three concise sentences.)

Relevant History

[Onset and course of symptoms; key comorbidities relevant to EDX interpretation such as diabetes, thyroid disease, chemotherapy, or renal failure; prior surgeries or injuries relevant to tested regions; occupational factors relevant to entrapment; prior EDX studies with date and conclusion if known] (Brief paragraph or tight bullets. If limited by source constraints, state the limitation.)

Focused Examination

[Targeted strength testing with muscle grades and asymmetries; reflexes with side-to-side comparison; sensory findings with distribution pattern; atrophy, tone changes, or fasciculations observed; provocative maneuvers if performed] (Document the neuromuscular exam elements that influenced nerve/muscle selection. May be formatted as paragraph or bullets.)

Technical Conditions and Limitations

• Limb temperature(s): [Value by limb/segment in °C] (Always document actual values)
• Warming performed: [Yes / No] (If yes, describe method briefly)
• [Technical factors affecting validity: edema, obesity, positioning, skin impedance] (Only if applicable)
• [Patient tolerance/cooperation issues impacting data quality] (Only if applicable)
• [Scope limitations with reason, e.g., paraspinals not tested due to anticoagulation] (Only if applicable)
• [If needle EMG or NCS not performed: "Not performed" with reason and impact on interpretation] (Only if applicable)

Study Performed

[Body regions tested] | [Modalities performed: sensory NCS, motor NCS, F-waves, H-reflex, repetitive stimulation, needle EMG] | Laboratory reference values were used for interpretation. (Brief summary, one to two sentences.)

Nerve Conduction Studies

Sensory NCS

Side	Nerve	Recording Site	SNAP Amplitude	Peak Latency	Conduction Velocity	Abnormal Flag
[Left / Right]	[Nerve name]	[Digit/Anatomic site]	[Value + units]	[Value + units]	[Value + units]	[Normal / Abnormal]
[Left / Right]	[Nerve name]	[Digit/Anatomic site]	[Value + units]	[Value + units]	[Value + units]	[Normal / Abnormal]

(Add or remove rows per nerves tested. If a study was attempted but technically inadequate, note as "Attempted—technically inadequate" with reason.)

Motor NCS

Side	Nerve	Recording Muscle	Stimulation Site	CMAP Amplitude	Distal Latency	Conduction Velocity	Abnormal Flag
[Left / Right]	[Nerve name]	[Muscle]	[Site(s)]	[Value + units]	[Value + units]	[Value + units]	[Normal / Abnormal]
[Left / Right]	[Nerve name]	[Muscle]	[Site(s)]	[Value + units]	[Value + units]	[Value + units]	[Normal / Abnormal]

(Add or remove rows per nerves tested. Note conduction block or temporal dispersion if identified. If technically inadequate, document reason.)

F-waves and H-reflexes

(Include table only if performed; otherwise state "Not performed" or omit section.)

Study Type	Side	Nerve	Minimum Latency	Abnormal Flag
[F-wave / H-reflex]	[Left / Right]	[Nerve]	[Value + units]	[Normal / Abnormal]

Repetitive Nerve Stimulation

(Include table only if performed; otherwise omit section entirely.)

Side	Nerve/Muscle	Stimulation Rate	Baseline Amplitude	Decrement/Increment	Abnormal Flag
[Left / Right]	[Nerve/Muscle]	[Hz]	[Value + units]	[% change and pattern]	[Normal / Abnormal]

Needle EMG

(List each muscle examined. Do not state "normal" without listing specific muscles. Document pain-limited or incomplete activation in the Comments column.)

Side	Muscle	Insertional Activity	Spontaneous Activity	MUAP Morphology	Recruitment Pattern	Comments
[Left / Right]	[Muscle name]	[Normal / Increased / Decreased]	[None / Fibs / PSWs / Fasciculations / CRDs / Myotonia]	[Normal / Neurogenic / Myopathic / Mixed]	[Normal / Reduced / Early]	[Pain-limited effort, poor activation, or other technical note]
[Left / Right]	[Muscle name]	[Normal / Increased / Decreased]	[None / Fibs / PSWs / Fasciculations / CRDs / Myotonia]	[Normal / Neurogenic / Myopathic / Mixed]	[Normal / Reduced / Early]	[Comments]

Paraspinals: [Tested / Not tested] [Findings if tested, or reason not tested]

Findings Summary

• Nerve conduction studies: [Nerves tested and whether normal or abnormal; specify abnormality type: prolonged latency, low amplitude, slowed velocity, conduction block, temporal dispersion]
• Needle EMG: [Muscles with abnormal findings and pattern: active denervation, chronic neurogenic changes, myopathic features; include distribution and side]
• Localization pattern: [Root / plexus / mononeuropathy / polyneuropathy / neuromuscular junction / myopathy pattern] (Organize by clinical significance.)

Impression

This study is [NORMAL / ABNORMAL].

• [Diagnosis #1]: [Localization: root/plexus/nerve/entrapment site/NMJ/muscle] | [Fiber type: sensory/motor/mixed] | [Pathophysiology: demyelinating/axonal/mixed] | [Distribution: focal/multifocal/generalized] | [Chronicity: acute/subacute/chronic; with or without active denervation] | [Severity: mild/moderate/severe, anchored to objective findings]
• [Diagnosis #2]: [Details as above] (Include additional diagnoses only if supported by data.)

Targeted negatives: [Explicit statements addressing the referral question and ruling out key alternate diagnoses or entrapment sites evaluated]

Limitations: [Technical factors, pain-limited exam, incomplete studies, temperature issues affecting conclusions] (Only if applicable)

Comparison: [Date of prior study and interval change assessment] (If no prior EDX available, state "No prior EDX available for comparison" or omit.)

Recommendations

• [Correlation with imaging, labs, or targeted clinical exam]
• [Follow-up EDX timing if symptoms progress or evolving process suspected]
• [Additional testing if study incomplete]
• [Clinical correlation statement if impression fully answers referral question]

(Include one to five actionable items when clinically indicated. Omit this section entirely if no recommendations are needed.)

Attestation

Interpreting Physician: [Name, credentials, electronic signature, date/time]

Technologist: [Name, role] (Only if applicable)

Trainee: [Name, role] (Only if applicable)