Get the free OUTSIDE MAMMOGRAM TRACKING FORM - Cedars-Sinai - cedars-sinai

PATIENT ID STICKER OUTSIDE MAMMOGRAM TRACKING FORM Thank you for bringing in your prior mammogram films / CD. To better serve you, please let us know what you would like us to do with these films

How to fill out outside mammogram tracking form

How to Fill Out Outside Mammogram Tracking Form:

1. Begin by carefully reading the instructions provided with the outside mammogram tracking form. Ensure that you understand the purpose and required information.
2. Start by entering your personal information, such as your full name, date of birth, address, and contact details. Double-check the accuracy of the information to avoid any errors.
3. Next, provide details about the healthcare facility or clinic where you received your mammogram. Include the name, address, and contact information of the facility.
4. Record the date when the mammogram was performed. This helps to keep track of your screening history and assists in scheduling future screenings.
5. Note down any relevant medical history or previous breast-related issues. This may include surgeries, biopsies, or any signs or symptoms that prompted the mammogram.
6. If you had any abnormal findings or were referred by another healthcare professional for the mammogram, make sure to mention it in the appropriate section.
7. Include information about your healthcare provider or physician who ordered the mammogram. Provide their name, contact information, and any additional details required.
8. If applicable, indicate whether you have insurance coverage and provide the necessary insurance company information. This helps with billing and coordination of healthcare services.
9. Finally, review the filled form to ensure all the information is accurate and complete. If required, sign and date the form as instructed.

Who Needs Outside Mammogram Tracking Form:

1. Women who have had or are scheduled to have a mammogram performed at a healthcare facility outside their regular healthcare system.
2. Individuals who are seeking a second opinion or specialized care may need to fill out an outside mammogram tracking form.
3. Those who are participating in research studies or clinical trials that involve mammograms performed at external facilities may be required to complete the form for tracking purposes.
4. Patients referred by their primary care physicians to outside facilities for specific mammography services may need to fill out the form to ensure proper communication and coordination between healthcare providers.

Please note that the specific requirements for filling out an outside mammogram tracking form might vary depending on the healthcare facility or organization. It is always best to follow the instructions provided with the form or consult with your healthcare provider for clarification.

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What is outside mammogram tracking form?

The outside mammogram tracking form is a form used to report mammograms conducted outside of a specific facility.

Who is required to file outside mammogram tracking form?

Healthcare facilities and providers are required to file the outside mammogram tracking form when mammograms are conducted outside of the facility.

How to fill out outside mammogram tracking form?

To fill out the outside mammogram tracking form, healthcare providers must input information about the patient, the outside facility where the mammogram was conducted, and the results of the mammogram.

What is the purpose of outside mammogram tracking form?

The purpose of the outside mammogram tracking form is to ensure that all mammogram results are properly recorded and tracked, even if the mammogram was conducted outside of the facility.

What information must be reported on outside mammogram tracking form?

The outside mammogram tracking form must include information about the patient, the outside facility where the mammogram was conducted, and the results of the mammogram.