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400 Taylor Blvd., Suite 105 Pleasant Hill, CA 94523 Phone (925) 826-1900 Fax (925) 826-1910 www.calimaging.com DIAGNOSTIC IMAGING REQUISITION Date: PATIENT INFORMATION Name Home Phone DOB Work/Cell
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How to fill out diagnostic imaging requisition
How to fill out a diagnostic imaging requisition:
01
Start by obtaining the necessary form or requisition from your healthcare provider or facility. This form will typically include fields for patient information, referring physician information, and details about the requested imaging study.
02
Begin by filling out the patient information section. This typically includes the patient's full name, date of birth, contact information, and any other relevant details requested.
03
Next, provide the name and contact information of the referring physician. This is crucial in ensuring that the results of the imaging study are properly communicated back to the referring healthcare provider.
04
Specify the reason for the imaging study in the appropriate section of the requisition form. This may require you to provide information about symptoms, medical history, or any specific concerns that are relevant to the requested imaging study.
05
Indicate the type of imaging study needed. This could include X-rays, MRIs, CT scans, ultrasounds, or any other specific modality. Detail any specific instructions or requirements for the imaging study if applicable.
06
If necessary, include any relevant supporting documentation. This may include medical records, lab results, or previous imaging studies that are necessary for the radiologist to properly interpret the images.
07
Finally, review the completed requisition form for accuracy and completeness. Ensure that all required fields are filled out and all information is correct. Any mistakes or missing information could potentially delay or complicate the scheduling and interpretation of the imaging study.
Who needs a diagnostic imaging requisition?
A diagnostic imaging requisition is typically needed by healthcare providers, such as physicians or specialists, who suspect or need further evaluation of a medical condition. This requisition allows them to request specific imaging studies, such as X-rays, MRIs, or CT scans, to gather more information about a patient's health condition. The requisition is then sent to a diagnostic imaging facility or radiology department where the requested imaging study will be performed and interpreted by a radiologist. The results of the imaging study are then communicated back to the referring healthcare provider, who will utilize the information to guide diagnosis, treatment, or further management of the patient's condition.
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What is diagnostic imaging requisition?
A diagnostic imaging requisition is a request or order for specific diagnostic tests such as X-rays, MRIs, or CT scans, typically filled out by a healthcare provider.
Who is required to file diagnostic imaging requisition?
Healthcare providers such as doctors, nurse practitioners, or physician assistants are typically required to file diagnostic imaging requisitions.
How to fill out diagnostic imaging requisition?
To fill out a diagnostic imaging requisition, healthcare providers must include patient information, reason for the test, type of test needed, and any relevant medical history.
What is the purpose of diagnostic imaging requisition?
The purpose of a diagnostic imaging requisition is to request specific tests that help healthcare providers diagnose and treat medical conditions.
What information must be reported on diagnostic imaging requisition?
Information such as patient demographics, reason for test, type of test needed, medical history, and referring provider information must be reported on a diagnostic imaging requisition.
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