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1A LOWER GI TEST REQUISITION ACCOUNT INFORMATION ACCOUNT NO. 1A PATIENT INFORMATION TELEPHONE NO. 1B CHART NUMBER 1B PATIENT D.O.B. ACCOUNT NAME AND ADDRESS PATIENT LAST NAME FIRST NAME M.I. STREET
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How to fill out lower gi test requisition
How to fill out a lower GI test requisition:
01
Begin by entering your personal information, such as your name, date of birth, and contact details, in the designated fields on the requisition form.
02
Next, provide information about your medical history, including any relevant symptoms or conditions that may have led to the need for the lower GI test.
03
Indicate the specific test you require in the appropriate section of the requisition form, ensuring that all necessary details, such as the type of test and any specific instructions, are accurately provided.
04
If applicable, provide details about your healthcare provider, including their name, contact information, and any additional information required, such as their clinic or hospital name.
05
Carefully review all the information you have filled in to ensure accuracy and completeness. Double-check that you have signed and dated the requisition form, as this may be necessary for processing.
06
Once you have filled out the form to your satisfaction, submit it to the relevant healthcare provider or laboratory as instructed by your healthcare professional.
Who needs a lower GI test requisition?
01
Individuals who are experiencing symptoms such as abdominal pain, rectal bleeding, changes in bowel habits, or unexplained weight loss may require a lower GI test.
02
Patients with a personal or family history of colon cancer, polyps, or inflammatory bowel disease may also be recommended to undergo a lower GI test as a preventive measure or to monitor their condition.
03
Healthcare providers may order a lower GI test requisition based on their clinical judgment, taking into account a patient's overall health, symptoms, medical history, and any other relevant factors.
Please note that it is important to consult with a qualified healthcare professional for precise instructions on filling out a lower GI test requisition and to determine if this test is necessary for your specific situation.
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What is lower gi test requisition?
Lower GI test requisition is a form used to request a lower gastrointestinal test such as a colonoscopy or sigmoidoscopy.
Who is required to file lower gi test requisition?
Lower GI test requisition is typically filed by a healthcare provider, such as a doctor or nurse, on behalf of a patient.
How to fill out lower gi test requisition?
To fill out a lower GI test requisition, the healthcare provider must provide the patient's information, reason for the test, and any relevant medical history.
What is the purpose of lower gi test requisition?
The purpose of lower GI test requisition is to request a lower gastrointestinal test to help diagnose or monitor conditions affecting the colon and rectum.
What information must be reported on lower gi test requisition?
The lower GI test requisition must include the patient's name, date of birth, reason for test, medical history, and any special instructions.
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