OHSU Physician Order Form for Imaging Services 2010 free printable template

Physician Order Form ? Imaging Services Diagnostic Imaging Services 3181 S.W. Sam Jackson Park Road, Portland OR 97239 Phone: 503-418-0990 Fax: 503-494-4621 Date: / / PATIENT INFORMATION Patient Name:

How to fill out ohsu imaging order form

How to fill out OHSU Physician Order Form for Imaging Services

1. Obtain the OHSU Physician Order Form for Imaging Services from the OHSU website or administrative office.
2. Fill in the patient's information including name, date of birth, and medical record number.
3. Clearly indicate the imaging services required (e.g., X-ray, MRI, CT scan, etc.).
4. Specify the clinical indication or reason for the imaging request.
5. Provide any necessary patient history or previous imaging results relevant to the current request.
6. Include the physician's information including name, contact number, and signature.
7. Review the form for completeness and accuracy.
8. Submit the form to the appropriate imaging department per OHSU protocols.

Who needs OHSU Physician Order Form for Imaging Services?

1. Physicians and healthcare providers who are referring patients for imaging services at OHSU.
2. Patients who require imaging services as part of their diagnosis or treatment plan.

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What is OHSU Physician Order Form for Imaging Services?

The OHSU Physician Order Form for Imaging Services is a standardized document used by healthcare providers to request imaging studies for patients at OHSU.

Who is required to file OHSU Physician Order Form for Imaging Services?

Healthcare providers, including physicians, physician assistants, and nurse practitioners, who need to request imaging services for their patients are required to file this form.

How to fill out OHSU Physician Order Form for Imaging Services?

To fill out the form, providers should complete all required fields such as patient information, requested imaging procedure, clinical indications, and any relevant patient history.

What is the purpose of OHSU Physician Order Form for Imaging Services?

The purpose of the form is to ensure accurate communication of imaging requests between healthcare providers and imaging departments, facilitating appropriate patient care.

What information must be reported on OHSU Physician Order Form for Imaging Services?

Required information includes patient demographics, reason for the imaging request, specific imaging modality (e.g., X-ray, MRI), and any pertinent clinical information that aids in the evaluation.