Get the free Nuclear Medicine NM Requisition - Providence Health Care

NM Nuclear Medicine (NM) Requisition SURNAME MR MISS MRS MS PERMANENT ADDRESS POSTAL CODE FIRST NAME CELL PHONE HOME PHONE WORK PHONE ST. PAUL HOSPITAL Nuclear Medicine Department 1081 Bernard St.,

How to fill out nuclear medicine nm requisition

How to fill out nuclear medicine NM requisition:

1. Begin by providing the necessary demographic information such as the patient's full name, date of birth, gender, and contact details. It is essential to ensure that all the information provided is accurate and up-to-date.
2. Next, specify the referring physician or healthcare provider who has requested the nuclear medicine procedure. Include their full name, contact information, and any other relevant details to ensure proper communication and coordination.
3. Indicate the reason for the nuclear medicine procedure by providing a brief medical history or clinical information. This should include the specific symptoms or condition that led to the request for nuclear medicine imaging.
4. Select the specific type of nuclear medicine study or procedure being requested. This could include options such as bone scan, myocardial perfusion imaging, PET/CT scan, or any other relevant test. It is important to be specific to ensure the correct procedure is performed.
5. Provide any additional specific instructions or requirements for the desired nuclear medicine study. This could include fasting instructions, medication restrictions or instructions, or any other special considerations that need to be communicated to the healthcare provider and patient.

Who needs nuclear medicine NM requisition:

1. Nuclear medicine NM requisitions are needed by patients who have been referred by their healthcare providers or physicians to undergo specific nuclear medicine imaging studies or procedures.
2. Patients with symptoms or medical conditions that require additional diagnostic information beyond what can be obtained from standard radiology imaging techniques may need a nuclear medicine NM requisition.
3. Nuclear medicine NM requisitions are commonly required for patients who need to assess organ function, identify tumors or metastases, evaluate cardiac health, or detect abnormalities at a molecular level.

Overall, the process of filling out a nuclear medicine NM requisition involves accurately providing patient information, specifying the desired procedure, and communicating any additional requirements or instructions. The requisition is typically required for patients referred by healthcare providers who need further diagnostic information through nuclear medicine imaging.

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