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Care Gram Pyelogram Date of Test: Test Time: Welcome to the Licking Memorial Hospital (LMA) Radiology Department. Your doctor has requested a pyelogram. A pyelogram is a Ray that uses a contrast medicine
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How to fill out your doctor has requested:

01
Gather all the necessary information: Start by collecting all the relevant information that your doctor has requested. This may include your personal details, medical history, current medications, and any recent test results.
02
Understand the purpose: Read through the doctor's request carefully to comprehend what they are specifically asking for. It could be a prescription refill, laboratory tests, medical records, or a specialist referral. Make sure to understand their requirements clearly before proceeding.
03
Complete the required forms: If there are any forms to be filled out, ensure you provide accurate and complete information. Pay attention to details such as contact information, insurance details, and previous medical procedures. Double-check for any errors to avoid delays or complications.
04
Provide supporting documents: If your doctor has requested any additional documents, such as lab reports or imaging results, make sure to include them along with the filled-out forms. These documents provide essential context for your doctor's request and aid in comprehensive medical evaluation.
05
Follow instructions: If your doctor has provided specific instructions regarding the submission method or any additional requirements, make sure to adhere to them. Follow their guidelines, whether it's submitting documents electronically, mailing them, or bringing them in person.

Who needs your doctor has requested?

01
Patients: Those who have received a doctor's request form need to fill it out accurately and provide the necessary information and supporting documents. This ensures that the doctor receives all the required information to make informed decisions about their healthcare.
02
Healthcare providers: Doctors, specialists, and other healthcare professionals are the ones who need the patient to fill out the requested forms. The information provided allows them to assess the patient's condition, provide appropriate treatments, prescribe medication, or refer the patient to a specialist if needed.
03
Medical institutions: Hospitals, clinics, and healthcare facilities also require the necessary forms to be filled out by the patient as part of their administrative procedures. These forms often contain vital information for record-keeping, billing purposes, and maintaining accurate patient records.
It is crucial to respect the doctor's request and promptly fill out the required forms, as it plays a significant role in maintaining effective communication and ensuring proper healthcare delivery.
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Your doctor has requested a copy of your medical records.
You are required to file the form requested by your doctor.
You can fill out the form online or by hand, following the instructions provided by your doctor.
The purpose of your doctor's request is to review your medical history and provide you with the best possible care.
You must report all your current medications, any allergies, past medical procedures, and any relevant family medical history.
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