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Primary Children s Medical Center A Service Of Intermountain Health Care 100 North Medical Drive, SLC, UT 84113 Utah Department of Health Treatment and Care Services Program/TB Control X-Ray Request
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What is x-ray request form?
The x-ray request form is a document used to request x-ray imaging tests for medical purposes.
Who is required to file x-ray request form?
Healthcare providers, doctors, or medical professionals are required to file the x-ray request form for their patients.
How to fill out x-ray request form?
The x-ray request form should be filled out by providing patient information, reason for the x-ray, and any specific instructions or requests.
What is the purpose of x-ray request form?
The purpose of the x-ray request form is to facilitate the scheduling and completion of x-ray imaging tests for medical diagnosis and treatment.
What information must be reported on x-ray request form?
The x-ray request form must include patient's name, date of birth, medical history, reason for x-ray, referring physician's information, and any special instructions.
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