Get the free Manchester PET-CT Scan Request - Dartmouth-Hitchcock - med dartmouth-hitchcock
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100 Hitchcock Way, Manchester NH 03104 Tel: 603695 2850 Fax: 603695 2856 PET/CT SCAN REQUEST PATIENT NAME DOB MR# BILLING PROVIDER ORDERING PROVIDER Has this patient had a prior PET scan? Yes No If
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How to fill out manchester pet-ct scan request
01
The Manchester PET-CT scan request form is typically filled out by healthcare professionals, such as physicians or radiologists, who require a PET-CT scan for their patients.
02
The requester must provide their full name, contact information, and professional credentials at the top of the form.
03
The patient's information should be accurately filled in, including their full name, date of birth, gender, and any relevant medical history or previous imaging studies.
04
The reason for the PET-CT scan request must be clearly stated. This can include suspected or known conditions related to cancer, infection, inflammation, or other specific indications.
05
The desired date and time for the scan appointment should be specified, as well as any preferences or special considerations.
06
Relevant clinical information, such as recent laboratory results, biopsy reports, or specific imaging findings, should be included to provide context for the scan.
07
If there are any specific instructions or requirements for the scan, such as fasting or medication restrictions, they should be clearly mentioned.
08
The requesting physician's signature and date of request are essential for authentication and documentation purposes.
09
It is important to double-check the form before submitting to ensure all necessary information has been provided.
Overall, filling out the Manchester PET-CT scan request form requires attention to detail, accurate patient information, and clear clinical context to facilitate the appropriate scheduling and performance of the PET-CT scan.
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What is manchester pet-ct scan request?
Manchester PET-CT scan request is a medical order for a Positron Emission Tomography and Computed Tomography scan in Manchester.
Who is required to file manchester pet-ct scan request?
Medical professionals such as doctors or specialists are required to file the Manchester PET-CT scan request.
How to fill out manchester pet-ct scan request?
To fill out Manchester PET-CT scan request, medical professionals need to provide patient information, reason for the scan, and any relevant medical history.
What is the purpose of manchester pet-ct scan request?
The purpose of Manchester PET-CT scan request is to help diagnose and monitor various medical conditions such as cancer, brain disorders, and heart diseases.
What information must be reported on manchester pet-ct scan request?
Information such as patient demographics, clinical indications for the scan, and any relevant lab results must be reported on Manchester PET-CT scan request.
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