Get the free Imaging Request Form - The New Malden Diagnostic Centre
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Imaging Request Form Patient name: Radiology Appointment Patient Category DOB: Date: Private: Patient No. X: Time: NHS: Address: Referring Doctor: Address for Results: Tel. No. Tel: Fax: Examination(s)
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What is imaging request form?
The imaging request form is a document used to request imaging services, such as X-rays, CT scans, or MRI scans.
Who is required to file imaging request form?
Medical professionals, such as doctors or healthcare providers, are usually required to file the imaging request form on behalf of their patients.
How to fill out imaging request form?
To fill out the imaging request form, you need to provide the patient's information, such as name, date of birth, and medical history. Additionally, you may need to indicate the specific type of imaging service requested and any relevant medical conditions that require imaging.
What is the purpose of imaging request form?
The purpose of the imaging request form is to facilitate the ordering and scheduling of imaging services for diagnostic or treatment purposes in healthcare settings.
What information must be reported on imaging request form?
The imaging request form typically requires the reporting of patient's personal information, medical history, specific imaging service requested, any relevant medical conditions, and doctor's contact information.
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