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Physician Order Form Imaging Services Diagnostic Imaging Services 3181 S.W. Sam Jackson Park Road, Portland, OR 97239 Phone: 5034180990 Fax: 5034944621 Date: / / PATIENT INFORMATION Patient Name (REQUIRED):

How to fill out 5034180990 form

How to fill out OHSU imaging order form:

1. Begin by accessing the OHSU website and navigating to the page where the imaging order form is available.
2. Carefully read the instructions provided on the form to familiarize yourself with the required information and any specific guidelines.
3. Fill out the patient information section accurately, including the patient's full name, date of birth, contact information, and relevant medical history.
4. If applicable, indicate the referring physician's information, including their name, address, and contact details.
5. Specify the type of imaging study to be performed by selecting the appropriate option from the provided choices or writing it in if not listed.
6. Indicate any specific areas or concerns to be focused on during the imaging study, if applicable.
7. If necessary, include any additional instructions or comments in the designated section.
8. Ensure that all sections of the form are completed and legible before submitting it.
9. Double-check the form for any errors or missing information before finalizing and submitting it.

Who needs OHSU imaging order form:

1. Patients who have been referred for an imaging study at OHSU by their healthcare provider.
2. Individuals who require diagnostic imaging to aid in the diagnosis or monitoring of their medical condition.
3. Healthcare professionals who are ordering imaging studies for their patients at OHSU.

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What is 5034180990?

5034180990 refers to a specific form or document, commonly used for reporting financial or tax-related information.

Who is required to file 5034180990?

Typically, individuals or organizations that meet certain financial thresholds or criteria set by the tax authorities are required to file this form.

How to fill out 5034180990?

To fill out the form 5034180990, follow the instructions provided by the issuing authority, ensuring that all required fields are completed with accurate information.

What is the purpose of 5034180990?

The purpose of 5034180990 is to collect specific information for tax compliance, financial reporting, or other regulatory requirements.

What information must be reported on 5034180990?

Information that must be reported on form 5034180990 typically includes financial data, identification details, and any other relevant information as specified by the form instructions.