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400 Taylor Blvd., Suite 105 Pleasant Hill, CA 94523 Phone (925× 8261900 Fax (925× 8261910 www.calimaging.com DIAGNOSTIC IMAGING REQUISITION Date: PATIENT INFORMATION Name Home Phone DOB Work×Cell

How to fill out diagnostic imaging requisition

1. Gather the necessary information: Before starting to fill out a diagnostic imaging requisition, you should ensure that you have all the required information. This typically includes the patient's name, date of birth, contact information, and relevant medical history.
2. Specify the type of imaging required: In the requisition, you need to specify the type of diagnostic imaging required. This could include X-rays, MRIs, CT scans, ultrasounds, or any other imaging modality. It is essential to accurately indicate the type of imaging needed for the patient's diagnosis.
3. Provide the reason for the imaging: You should clearly state the reason for the diagnostic imaging on the requisition form. This could be symptoms the patient is experiencing, a specific condition being investigated, or any relevant history that necessitates imaging. The more precise and comprehensive the reason, the easier it will be for the clinician interpreting the images to provide an accurate diagnosis.
4. Indicate any specific instructions or requests: If there are any specific instructions or requests concerning the imaging procedure, it is crucial to include them on the requisition. For example, if the patient needs to be fasting before an abdominal ultrasound, or if you require the results to be expedited due to urgent clinical need, make sure to clearly state these instructions on the form.
5. Include the referring physician's details: The diagnostic imaging requisition should include the referring physician's name, contact information, and signature. This allows the imaging facility to communicate with the referring physician and send the results directly to them. It is important to ensure that the referring physician's details are accurately provided to avoid any delays or miscommunication.
6. Submit the requisition to the imaging facility: Once you have completed filling out the requisition form, make sure to submit it to the appropriate imaging facility. Different healthcare providers may have different processes for submission, including online portals, faxing, or physically delivering the form. Follow the instructions provided by the imaging facility to ensure a smooth and timely process.

Who needs a diagnostic imaging requisition?

A diagnostic imaging requisition is typically required for individuals who need to undergo specific imaging procedures to aid in their diagnosis or treatment. This may include patients referred by primary care physicians, specialists, surgeons, or other healthcare providers. The requisition ensures that the imaging facility performs the appropriate imaging tests based on the patient's medical condition and provides the necessary information to interpret and report the results accurately. Ultimately, anyone who requires diagnostic imaging as part of their medical care would need a diagnostic imaging requisition.

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What is diagnostic imaging requisition?

Diagnostic imaging requisition is a form requesting a specific type of medical imaging test for a patient.

Who is required to file diagnostic imaging requisition?

Healthcare providers such as doctors, nurse practitioners, or specialists are required to file diagnostic imaging requisitions.

How to fill out diagnostic imaging requisition?

Diagnostic imaging requisitions can typically be filled out by providing patient information, test required, reason for the test, and any additional notes.

What is the purpose of diagnostic imaging requisition?

The purpose of diagnostic imaging requisition is to order a specific imaging test in order to diagnose or monitor a patient's medical condition.

What information must be reported on diagnostic imaging requisition?

Information such as patient demographics, test requested, reason for test, healthcare provider's information, and any relevant medical history must be reported on diagnostic imaging requisition.