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TX Medical City Dallas Hospital PET/CT Scan Order Form 2010-2026 free printable template

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PET/CT SCAN ORDER FORM Scheduling: 972-566-EXAM (3926) Images: Di-com CD Fax: 1-866-743-2104 Printed Images Date of Order: Send w/Patient To be picked up Other JPEG CD For Images marked others please
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How to fill out simonmed imaging referral form

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How to fill out TX Medical City Dallas Hospital PET/CT Scan

01
Obtain a referral from your physician for the PET/CT scan.
02
Contact TX Medical City Dallas Hospital to schedule an appointment.
03
Verify your insurance coverage and understand any co-pays or deductibles.
04
Prepare for the scan by fasting for a specified period (usually 4-6 hours) as instructed.
05
Arrive at the hospital on the scheduled date and time.
06
Complete any necessary pre-scan paperwork and provide your medical history.
07
Undergo the PET/CT scan, which typically involves an injection of a radioactive tracer and waiting for it to circulate.
08
Follow any post-scan instructions provided by the medical staff.

Who needs TX Medical City Dallas Hospital PET/CT Scan?

01
Patients with suspected cancers to assess tumor presence or metastasis.
02
Individuals being evaluated for unexplained pain or weight loss.
03
Patients undergoing treatment for cancer to monitor therapy effectiveness.
04
People with certain neurological disorders, such as Alzheimer's disease, for further evaluation.
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John Simon is the founder and CEO of SimonMed Imaging.
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SimonMed Imaging is headquartered in Scottsdale, AZ and has 69 office locations located throughout the US.
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The TX Medical City Dallas Hospital PET/CT Scan is a specialized imaging procedure that combines positron emission tomography (PET) and computed tomography (CT) to provide detailed information about the body's metabolic activity and anatomical structure.
Patients who have been referred by their physician for evaluation of specific medical conditions, such as cancer, neurological disorders, or cardiac issues, are required to undergo a PET/CT scan at TX Medical City Dallas Hospital.
To fill out the PET/CT scan forms, patients must provide personal information such as full name, date of birth, medical history, and the reason for the scan as specified by their referring physician.
The purpose of the PET/CT scan is to help diagnose, stage, and monitor treatment responses for various diseases, predominantly cancer, by visualizing metabolic activity and structure in the body.
The information that must be reported includes patient demographics, medical history, indication for the scan, the type of tracer used, and the findings from the imaging results to guide further clinical decisions.
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