Get the free OUTPATIENT ULTRASOUND REFERRAL - MSPCA-Angell

Diagnostic Imaging Department 350 S. Huntington Ave., Boston, MA 02130 Phone (617) 541-5139 Fax (617) 989-1617 OUTPATIENT ULTRASOUND REFERRAL Please fill out and fax this form to 617-989-1617 before

How to fill out outpatient ultrasound referral

How to fill out outpatient ultrasound referral:

1. Start by obtaining the necessary referral form from your healthcare provider or the outpatient ultrasound facility.
2. Fill in your personal information, including your full name, date of birth, address, and contact number.
3. Provide your insurance information, including your insurance company name, policy number, and any other required details.
4. Specify the reason for the referral, whether it is for a specific medical condition, diagnostic purposes, or routine screening.
5. Include any relevant medical history or previous imaging results that may help the ultrasound technician or radiologist in interpreting the results.
6. If there are any specific areas of concern or particular tests that need to be conducted during the ultrasound, make sure to clearly state them in the referral.
7. Ensure that the referring healthcare provider signs and dates the referral form, as this is necessary for it to be considered valid.

Who needs outpatient ultrasound referral:

1. Individuals who require diagnostic imaging for medical evaluation or monitoring may need an outpatient ultrasound referral.
2. Patients who have been experiencing symptoms or have indications of a potential medical condition that requires further examination may also need a referral.
3. Individuals with a history of certain medical conditions, such as kidney disease, gallstones, pregnancy, or cardiovascular issues, may require an outpatient ultrasound referral for ongoing monitoring or evaluation.

For pdfFiller’s FAQs

What is outpatient ultrasound referral?

Outpatient ultrasound referral is a request made by a healthcare provider for a patient to undergo an ultrasound outside of a hospital setting.

Who is required to file outpatient ultrasound referral?

Healthcare providers such as doctors or physician assistants are required to file outpatient ultrasound referrals for their patients.

How to fill out outpatient ultrasound referral?

Outpatient ultrasound referrals can be filled out by providing the patient's information, reason for referral, and any other relevant medical history.

What is the purpose of outpatient ultrasound referral?

The purpose of outpatient ultrasound referral is to diagnose or monitor medical conditions through the use of ultrasound technology.

What information must be reported on outpatient ultrasound referral?

Information such as patient demographics, reason for referral, ordering provider details, and any relevant clinical information must be reported on outpatient ultrasound referral.

Can I create an electronic signature for the outpatient ultrasound referral in Chrome?

Yes, you can. With pdfFiller, you not only get a feature-rich PDF editor and fillable form builder but a powerful e-signature solution that you can add directly to your Chrome browser. Using our extension, you can create your legally-binding eSignature by typing, drawing, or capturing a photo of your signature using your webcam. Choose whichever method you prefer and eSign your outpatient ultrasound referral in minutes.

How can I edit outpatient ultrasound referral on a smartphone?

You may do so effortlessly with pdfFiller's iOS and Android apps, which are available in the Apple Store and Google Play Store, respectively. You may also obtain the program from our website: https://edit-pdf-ios-android.pdffiller.com/. Open the application, sign in, and begin editing outpatient ultrasound referral right away.

Can I edit outpatient ultrasound referral on an Android device?

Yes, you can. With the pdfFiller mobile app for Android, you can edit, sign, and share outpatient ultrasound referral on your mobile device from any location; only an internet connection is needed. Get the app and start to streamline your document workflow from anywhere.