Get the free Mammogram Dexa Scan Referral Form - bmhsc

MAMMOGRAM/DEXA SCAN REFERRAL FORM Page 1 of 1 This request for service must accompany the patient at the time of service. Elective Routine Urgent Emergency within 24 hours Pt Acct #: PATIENT INFORMATION

How to fill out mammogram dexa scan referral

How to fill out a mammogram dexa scan referral:

1. Start by obtaining the referral form from your healthcare provider. This can typically be done during a consultation or by requesting it from your doctor's office.
2. Ensure that the referral form includes your personal information such as your name, date of birth, contact information, and any relevant medical history. It is crucial to provide accurate information for proper identification and tracking of your referral.
3. Fill in the date when you received the referral form. This will help indicate when the referral was made and can be useful for tracking purposes.
4. Indicate the healthcare provider who is referring you for the mammogram dexa scan. This should include their full name, contact information, and any relevant identification or license number.
5. Specify the reason for the referral. In this case, mention that it is for a mammogram dexa scan. It is important to be clear and specific to ensure that the necessary tests are conducted.
6. If there are any additional notes or specific instructions provided by your healthcare provider, ensure that you include them accurately on the referral form. This may include particular concerns, medical conditions, or requirements that need to be addressed during the scan.
7. Review the completed referral form for any errors or omissions before submitting it. Make sure that all information is legible and correct to avoid any potential issues or delays in scheduling your mammogram dexa scan.

Who needs a mammogram dexa scan referral?

1. Individuals who are experiencing breast-related symptoms such as lumps, pain, or changes in appearance may require a mammogram dexa scan referral. This referral helps determine if there are any abnormalities or potential risks that need further evaluation.
2. Patients who fall under certain age groups or have specific risk factors for breast cancer may be advised to undergo regular mammogram dexa scans as a preventive measure. These individuals may need a referral from their healthcare provider to initiate the process.
3. Following certain medical procedures, such as breast biopsies or surgeries, a mammogram dexa scan referral may be necessary to monitor the area or evaluate the effectiveness of the treatment.
4. Healthcare providers may also recommend a mammogram dexa scan referral for individuals with a family history of breast cancer or other related conditions. This helps identify potential risks or genetic factors that could influence future screenings or preventive measures.

Remember, always consult with your healthcare provider for personalized guidance on obtaining a mammogram dexa scan referral, as individual circumstances may vary.

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What is mammogram dexa scan referral?

Mammogram dexa scan referral is a medical referral for a mammogram and DEXA scan, which are imaging tests used to screen for breast cancer and osteoporosis, respectively.

Who is required to file mammogram dexa scan referral?

Patients who are recommended to undergo a mammogram and DEXA scan by their healthcare provider are required to file the referral.

How to fill out mammogram dexa scan referral?

To fill out a mammogram dexa scan referral, patients need to provide their personal information, healthcare provider details, reason for referral, and any relevant medical history.

What is the purpose of mammogram dexa scan referral?

The purpose of a mammogram dexa scan referral is to ensure that patients receive timely and appropriate screening tests for breast cancer and osteoporosis.

What information must be reported on mammogram dexa scan referral?

The information reported on a mammogram dexa scan referral includes patient demographics, healthcare provider information, reason for referral, and any relevant medical history or symptoms.