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This document is an order form for breast imaging services including screening and diagnostic mammography, ultrasounds, and image-guided procedures. It requires information about the ordering provider,

How to fill out uwhc radiology outpatient order

How to fill out UWHC Radiology Outpatient Order Form

1. Obtain the UWHC Radiology Outpatient Order Form from the designated source.
2. Fill in the patient's demographic information at the top of the form, including name, date of birth, and contact details.
3. Indicate the referring physician’s name and contact information clearly to ensure proper communication.
4. Specify the type of radiology procedure required by checking the appropriate box or writing it in the space provided.
5. Include any relevant clinical information that might assist in the interpretation of the radiological exam under the 'Clinical History' section.
6. Ensure the form is signed and dated by the referring physician.
7. Review the completed form for any missing information or errors before submitting.
8. Submit the form to the radiology department as instructed, either via fax, email, or in person.

Who needs UWHC Radiology Outpatient Order Form?

1. Healthcare providers and physicians who are referring patients for radiological imaging services at UWHC.
2. Patients who are scheduled for outpatient radiology services and need documentation for their visit.

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What is UWHC Radiology Outpatient Order Form?

The UWHC Radiology Outpatient Order Form is a document used by healthcare providers to request radiology services for outpatient procedures at the University of Wisconsin Hospital and Clinics (UWHC).

Who is required to file UWHC Radiology Outpatient Order Form?

Healthcare providers, including physicians and nurse practitioners, who require radiology services for their patients are required to file the UWHC Radiology Outpatient Order Form.

How to fill out UWHC Radiology Outpatient Order Form?

To fill out the UWHC Radiology Outpatient Order Form, the provider must provide patient information, select the appropriate radiology services needed, and indicate clinical indications as well as any relevant patient history.

What is the purpose of UWHC Radiology Outpatient Order Form?

The purpose of the UWHC Radiology Outpatient Order Form is to facilitate the request for radiology services, ensuring that appropriate information is communicated to the radiology department for patient care.

What information must be reported on UWHC Radiology Outpatient Order Form?

The UWHC Radiology Outpatient Order Form must report patient demographics, specific radiology exams requested, clinical indications, any relevant medical history, and the referring provider's information.