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Larger Medical Building 4010 Aerial Way Eugene, OR 97402 Phone: (541) 2428300 FAX: (541) 2428335 OSTEOPOROSIS ASSESSMENT CONSULTATION REQUISITION OFFICE USE ONLY: FAXED REQUISITION: CONSULTATION PACKET

How to fill out osteoporosis assessment consultation requisition

To fill out an osteoporosis assessment consultation requisition, follow these steps:

1. Begin by filling in your personal information, including your full name, date of birth, gender, and contact information.
2. Indicate your medical history, including any current medications you are taking and any previous diagnoses or treatments related to bone health or osteoporosis.
3. Provide information about your family history of osteoporosis or any other bone-related conditions.
4. Specify any symptoms or concerns you have related to osteoporosis, such as bone pain, fractures, or low bone density.
5. If applicable, include the name and contact information of the healthcare professional who referred you for a consultation.
6. Check any relevant checkboxes or answer yes/no questions related to your lifestyle factors, such as smoking habits, alcohol consumption, dietary habits, and physical activity level.
7. If you have had any previous bone density tests or other osteoporosis assessments, provide the date and name of the facility or healthcare professional who performed the evaluation.
8. Finally, sign and date the requisition form to validate your consent for the osteoporosis assessment consultation.

Who needs an osteoporosis assessment consultation requisition?

1. Individuals who have a family history of osteoporosis or bone-related conditions may benefit from an osteoporosis assessment consultation. Understanding your risk factors can help guide preventive measures or early detection.
2. Individuals experiencing symptoms or concerns related to osteoporosis, such as bone pain, frequent fractures, or low bone density, should consider obtaining an osteoporosis assessment consultation requisition. This can help determine the underlying cause of their symptoms and guide appropriate treatment plans.
3. Healthcare professionals may also recommend an osteoporosis assessment consultation requisition for individuals who are at higher risk due to certain lifestyle factors, such as smoking, excessive alcohol consumption, poor dietary habits, or lack of physical activity.

Remember, it is important to consult with a healthcare professional to determine if an osteoporosis assessment consultation is necessary and to receive personalized recommendations based on your individual circumstances.

For pdfFiller’s FAQs

What is osteoporosis assessment consultation requisition?

The osteoporosis assessment consultation requisition is a form used to request a consultation with a healthcare professional to assess and evaluate a patient's risk for osteoporosis.

Who is required to file osteoporosis assessment consultation requisition?

The requisition can be filed by a referring physician or healthcare provider who believes a patient may be at risk for osteoporosis and in need of further assessment.

How to fill out osteoporosis assessment consultation requisition?

The requisition should be filled out with the patient's information, medical history, reason for referral, and any relevant test results.

What is the purpose of osteoporosis assessment consultation requisition?

The purpose of the requisition is to facilitate a consultation with a specialist to assess the patient's risk for osteoporosis and determine appropriate treatment and management.

What information must be reported on osteoporosis assessment consultation requisition?

The requisition should include the patient's name, contact information, referral reason, relevant medical history, and any recent test results related to bone health.

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