Get the free PETCT ORDER FORM - mtbakerimagingfileswordpresscom

PET/CT ORDER FORM Scheduling: (360) 6472422 Fax: (360) 2552263 Your PET/CT study is scheduled for: 2930 Aquarium Parkway, Suite 201 Bellingham, WA 98225 Date: Time: 2. Date of Birth 3. Height 4. Weight

How to fill out petct order form

How to fill out a PETCT order form:

1. Start by carefully reading the instructions at the top of the form. These instructions will provide specific details on how to complete the form accurately.
2. Begin by entering the patient's personal information, including their full name, date of birth, and contact details. It is crucial to ensure the accuracy and legibility of this information for proper identification.
3. Provide the referring physician's information, including their full name, contact details, and any relevant identification numbers or affiliations they may have.
4. Specify the reason for the PETCT scan. This may include the suspected diagnosis, symptoms, or any other relevant medical history that can assist the radiologist in interpreting the results.
5. Indicate the specific test or study requested. This could be a whole-body scan, a specific organ evaluation, or any other specific instructions provided by the referring physician.
6. Enter any additional instructions or comments that may be necessary for the radiologist or the medical staff performing the scan. This could include any allergies, specific concerns, or previous imaging studies relevant to the current evaluation.
7. If applicable, provide details about the type of contrast medium to be used during the scan. This information is typically determined by the referring physician based on the patient's medical history or specific medical condition.
8. Review the completed form to ensure all the information provided is accurate and complete. Mistakes or missing information may lead to delays or misinterpretation of the scan results.

Who needs a PETCT order form:

1. Medical practitioners or referring physicians who suspect a patient may have a specific medical condition or require further evaluation.
2. Patients who have been advised by their primary care physician or specialist to undergo PETCT imaging for diagnostic purposes.
3. Hospitals, clinics, or medical facilities that offer PETCT scanning services and require a specific order form for documentation and scheduling purposes.

For pdfFiller’s FAQs

What is petct order form?

It is a form used to request a PET/CT scan for medical purposes.

Who is required to file petct order form?

Medical professionals such as physicians or specialists are required to file the PET/CT order form.

How to fill out petct order form?

The form should be filled out with the patient's information, reason for the scan, and any relevant medical history.

What is the purpose of petct order form?

The purpose is to request a PET/CT scan to help diagnose or monitor medical conditions.

What information must be reported on petct order form?

Patient information, reason for the scan, medical history, and any relevant details for the scan.

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