The Exam Form is used to collect all patient, baseline and annual screening exam, follow-up exam, and additional risk factor data. The attached PDF form is available for your convenience to collect information for manual entry, if desired.

Please do not mail forms to the ACR

Form Version: 1.19 (corresponds to LCSR File Version 1.5)

After June 30, 2021, only Versions 1.3,  1.4  and 1.5 of LCSR will be accepted. After November 1, 2021, only Version 1.5 will be accepted.