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CT Maxillofacial Imaging Request (Page 1 of 2) Completion of this form is the minimum required information to start a case. In some cases, additional clinical information is required. Resolution reserves

How to fill out ct maxillofacial imaging request

How to fill out a CT Maxillofacial Imaging Request:

1. Start by providing your personal information: Include your full name, date of birth, contact information, and any relevant identification numbers or medical record numbers.
2. Identify the reason for the request: Indicate the specific purpose for the CT maxillofacial imaging, such as trauma evaluation, suspected pathology, or pre-operative planning.
3. Specify any relevant symptoms or findings: Provide details about any symptoms or physical findings that prompted the need for the imaging. This can help guide the radiologist's interpretation.
4. Note any relevant medical history: Mention any past medical conditions, surgeries, or treatments, and any relevant current medications or allergies. This information can impact the imaging procedure and interpretation.
5. Include any relevant referral details: If the CT maxillofacial imaging request is being made by another healthcare professional, include their name, contact information, and any specific concerns or questions they may have.
6. Specify the imaging parameters: Indicate the anatomical area of interest, such as the jaw, sinuses, or temporal bones. Provide any specific instructions for the radiology technologist, such as the need for contrast enhancement or a specific imaging protocol.
7. Verify insurance information: Include your insurance provider, policy number, and any required pre-authorization or referral information. This ensures proper billing and coverage for the imaging procedure.
8. Sign and date the request: Finally, don't forget to sign and date the CT maxillofacial imaging request. This verifies your consent and authorizes the imaging procedure to be performed.

Who needs a CT Maxillofacial Imaging Request:

1. Individuals with suspected maxillofacial trauma: This may include patients who have suffered facial fractures, dental injuries, or other traumas to the maxillofacial region.
2. Individuals with suspected pathology: If a healthcare professional suspects the presence of tumors, infections, cysts, or other abnormalities in the maxillofacial area, they may request a CT scan for further evaluation.
3. Individuals undergoing pre-operative planning: CT maxillofacial imaging can be helpful in planning for surgical procedures involving the face, jaw, or sinuses. It provides detailed information about the anatomy and can aid in surgical decision-making.

In summary, filling out a CT maxillofacial imaging request involves providing personal information, specifying the reason for the request, and providing details about symptoms, medical history, and referral information. CT maxillofacial imaging may be needed for individuals with suspected maxillofacial trauma, suspected pathology, or those undergoing pre-operative planning.

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What is ct maxillofacial imaging request?

The ct maxillofacial imaging request is a medical order for a computed tomography scan of the head and neck area.

Who is required to file ct maxillofacial imaging request?

Medical professionals such as doctors or dentists are required to file a ct maxillofacial imaging request.

How to fill out ct maxillofacial imaging request?

To fill out a ct maxillofacial imaging request, the medical professional must provide patient information, reason for the scan, and any relevant medical history.

What is the purpose of ct maxillofacial imaging request?

The purpose of a ct maxillofacial imaging request is to diagnose and monitor conditions affecting the head and neck area.

What information must be reported on ct maxillofacial imaging request?

The ct maxillofacial imaging request must include patient demographics, clinical history, and the specific reason for the scan.