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Patients Name Exam Date Time Signature of Ordering Physician ORDER FORM MAMMOGRAPHY Scheduling Phone (207 2837171 Dear Patient: Thank you for choosing Southern Maine Medical Center (MMC) to provide
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What is physician order form mammography?
Physician order form mammography is a form that informs the radiology department that a patient needs to undergo a mammogram.
Who is required to file physician order form mammography?
Physicians or healthcare providers who want their patients to undergo a mammogram are required to file the physician order form.
How to fill out physician order form mammography?
A physician or healthcare provider can fill out the physician order form by providing the patient's information, reason for the mammogram, and any relevant medical history.
What is the purpose of physician order form mammography?
The purpose of the physician order form is to ensure that a patient receives the necessary mammogram in a timely manner.
What information must be reported on physician order form mammography?
The physician order form must include the patient's name, date of birth, reason for the mammogram, referring physician, and any relevant medical history.
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