Valley Hospital PET/CT Scan Referral Form 2012-2025 free printable template

THE VALLEY HOSPITAL 223 N. Van died Ave Ridge wood, NJ 07450 PET/ CT Scan Referral form Phone# 201-251-3543 Exam Requested: Fax# 201-447-8576 PET/CT Skull Base to mid-thigh (CPT: 78815) PET/CT Whole

How to fill out Valley Hospital PETCT Scan Referral Form

How to fill out Valley Hospital PET/CT Scan Referral Form

1. Obtain the Valley Hospital PET/CT Scan Referral Form from the hospital's website or the referral office.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Provide details about the referring physician, including their name, contact information, and specialty.
4. Specify the relevant clinical information that justifies the need for the PET/CT scan, including symptoms and medical history.
5. Indicate any prior imaging studies that are relevant to the referral.
6. Select the appropriate date and time preferences for the appointment, if available.
7. Sign and date the form, confirming that all information provided is accurate.
8. Submit the completed form to the referral office either electronically or in person.

Who needs Valley Hospital PET/CT Scan Referral Form?

1. Patients who require a PET/CT scan for diagnostic purposes.
2. Referring physicians who need to document and authorize the request for imaging.
3. Individuals involved in patient care decisions where PET/CT imaging is necessary.

People Also Ask about

How do you read a CT scan report?

In order to read a CT scan, you must consider the colors white, gray, and black. Each color represents a distinct part of your body: soft tissues, fat, air, and bone. A change in color in a specific area of your body might indicate the presence of an abnormality. Dense tissues, such as bone, are seen as white patches.

How do you describe CT findings?

When describing findings on CT, we use words that refer to how dense the abnormality is in relation to a reference structure. Reference structures include bone, gray matter, white matter, CSF, fat, air etc.

How do you write CAT scan?

Also called computed tomography scan, computerized axial tomography scan, computerized tomography, and CT scan.

How do you describe CT scan findings?

The appearance of tissues on a CT scan is described in terms of 'density'. Darker structures are 'hypodense or low density'; brighter structures are 'hyperdense or high density'. Blood Can Be Very Bad is a mnemonic that can be used when faced with interpreting a CT head scan: Blood.

How do you read CT scan results?

In order to read a CT scan, you must consider the colors white, gray, and black. Each color represents a distinct part of your body: soft tissues, fat, air, and bone. A change in color in a specific area of your body might indicate the presence of an abnormality. Dense tissues, such as bone, are seen as white patches.

What is CT scan terminology?

The term “computed tomography,” or CT, refers to a computerized x-ray imaging procedure in which a narrow beam of x-rays is aimed at a patient and quickly rotated around the body, producing signals that are processed by the machine's computer to generate cross-sectional images, or “slices.”

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What is Valley Hospital PET/CT Scan Referral Form?

The Valley Hospital PET/CT Scan Referral Form is a document that healthcare providers use to refer patients for a PET/CT scan, which is a type of medical imaging that combines positron emission tomography (PET) and computed tomography (CT) to produce detailed images of the body's functional and structural activity.

Who is required to file Valley Hospital PET/CT Scan Referral Form?

Healthcare providers, such as physicians or specialists, who determine that a patient requires a PET/CT scan are required to complete and file the Valley Hospital PET/CT Scan Referral Form.

How to fill out Valley Hospital PET/CT Scan Referral Form?

To fill out the Valley Hospital PET/CT Scan Referral Form, healthcare providers should include patient information, the reason for the scan, relevant medical history, and any specific preparations or requirements for the procedure as indicated on the form.

What is the purpose of Valley Hospital PET/CT Scan Referral Form?

The purpose of the Valley Hospital PET/CT Scan Referral Form is to facilitate the referral process, ensuring that all necessary information is communicated between the referring provider and the imaging center for proper scheduling and patient care.

What information must be reported on Valley Hospital PET/CT Scan Referral Form?

The Valley Hospital PET/CT Scan Referral Form must report information such as patient demographics (name, age, contact details), medical history, the indication for the scan, clinical information, and any special instructions for the imaging procedure.