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Get the free CT Lung Screening Order Form - dignityhealthorg

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Cancer Institute CT Lung Screening Order Form Patient Name DOB / / Patient Phone Number Packs/day (20 cigarettes/packs): x Years smoked: Pack years*: *Pack year calculator http://smokingpackyears.com
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How to fill out ct lung screening order

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How to fill out a CT lung screening order:

01
Start by obtaining a CT lung screening order form from a healthcare provider or a medical facility.
02
Fill in the patient's personal information, including their full name, date of birth, contact information, and any relevant medical history.
03
Provide the ordering physician's information, including their name, specialty, contact details, and their National Provider Identifier (NPI) number.
04
Specify the reason for the CT lung screening order. This could be based on risk factors such as smoking history, exposure to asbestos, or a family history of lung cancer.
05
Indicate any additional tests or procedures that need to be performed alongside the CT lung screening, if necessary.
06
Make sure to include the date when the order is being filled out.
07
Ensure that all required signatures are included, both from the ordering physician and the patient (if applicable).
08
Submit the completed CT lung screening order to the appropriate department or scheduling office.

Who needs a CT lung screening order?

01
Individuals who have a history of heavy smoking and are between the ages of 55 and 80 may need a CT lung screening order. This includes current smokers or those who have quit smoking within the past 15 years.
02
Individuals who have been exposed to asbestos or other occupational lung irritants may require a CT lung screening order.
03
People with a family history of lung cancer or other risk factors may also benefit from obtaining a CT lung screening order to assess their lung health and detect any potential abnormalities.
Remember, it is always important to consult with a healthcare provider who can evaluate your specific situation and determine if a CT lung screening order is necessary for you.
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CT lung screening order is a medical imaging test that uses specialized x-ray technology to look at structures and nodules in the lungs.
A healthcare provider, typically a doctor or radiologist, is required to order a CT lung screening for a patient.
The healthcare provider can fill out a CT lung screening order by indicating the patient's information, reason for the test, and any specific instructions.
The purpose of a CT lung screening order is to detect lung cancer or other abnormalities in the lungs at an early stage for timely treatment.
The CT lung screening order must include the patient's name, date of birth, reason for the test, any relevant medical history, and the healthcare provider's details.
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