Get the free Imaging Requisition Form - Medical Center of Aurora
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South Campus 1501 S. Potomac Street Aurora, CO 80012 303.695.2641 Outpatient Imaging Center 1400 S. Potomac Street Suite 100 & 180 Aurora, CO 80012 303.695.2711 opt 7 303.873.5229 North Campus 700
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How to fill out imaging requisition form
How to fill out an imaging requisition form:
01
Start by gathering all the necessary information. This may include the patient's name, date of birth, contact information, and insurance details.
02
Next, provide the reason for the imaging request. Specify the type of imaging needed, such as an X-ray, MRI, or CT scan, and provide a detailed description of the symptoms or medical condition that warrant the imaging.
03
Fill out the referring physician's information. Include their name, contact details, and any relevant medical practice or facility they belong to.
04
Indicate the preferred imaging facility or radiology center where the imaging will take place. Include the facility's name, address, and contact information.
05
If applicable, provide any special instructions or comments for the radiologist or imaging technician. This could include specific areas to focus on, any allergies or medications the patient may have, or any previous imaging studies that need to be compared.
06
Ensure that the form is complete and legible. Double-check all the provided information for accuracy and make sure all required fields have been filled out.
Who needs an imaging requisition form:
01
Patients who require diagnostic imaging as part of their medical evaluation or treatment may need an imaging requisition form. This includes individuals experiencing specific symptoms that need further investigation or those with known medical conditions that require monitoring or evaluation through imaging.
02
Physicians and healthcare providers who suspect a potential underlying medical condition and require imaging to confirm their diagnosis may need to fill out an imaging requisition form. This includes primary care doctors, specialists, surgeons, and other healthcare professionals involved in the patient's care.
03
Insurance companies and third-party payers may also require an imaging requisition form before approving coverage for the requested imaging procedure. This allows them to review the medical necessity and appropriateness of the imaging before providing coverage for the service.
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What is imaging requisition form?
Imaging requisition form is a document used to request imaging tests such as X-rays, MRIs, or CT scans.
Who is required to file imaging requisition form?
Healthcare providers, physicians, or medical professionals are required to file imaging requisition forms on behalf of the patients.
How to fill out imaging requisition form?
To fill out an imaging requisition form, one must provide patient information, reason for the imaging test, type of imaging test needed, and any relevant medical history.
What is the purpose of imaging requisition form?
The purpose of imaging requisition form is to request and authorize imaging tests for diagnostic or treatment purposes.
What information must be reported on imaging requisition form?
The imaging requisition form must include patient demographics, medical history, reason for the test, type of test needed, ordering physician information, and any relevant clinical notes.
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