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Breast Imaging Order Form Today's Date: REPORTING INSTRUCTIONS Routine General Scheduling: (541× 3347555 TF: (888× 9687608 Fax Orders: (541× 3347564 (Do not fax STAT orders) STAT Call Report direct
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How to fill out breast imaging order form
How to fill out a breast imaging order form:
01
Start by gathering all the necessary information needed to complete the form. This typically includes the patient's personal information such as name, age, gender, and contact details.
02
Next, provide the relevant medical history of the patient. This may include previous breast imaging results, family history of breast cancer, or any other relevant information that could assist the radiologist in the interpretation of the images.
03
Indicate the reason for the breast imaging order. This could be based on symptoms that the patient is experiencing, abnormal findings on a physical examination, or as part of routine breast cancer screening.
04
Specify the type of breast imaging study required. This could include mammography, ultrasound, magnetic resonance imaging (MRI), or any other specific imaging modality recommended for the patient.
05
Include any additional instructions or requests for the radiologist. For example, if the patient has breast implants, it is important to mention this as it may require additional imaging considerations.
06
Finally, ensure that all the necessary signatures and dates are provided. This may include the authorization of the ordering physician, patient consent, or any other required signatures.
Who needs a breast imaging order form?
01
Individuals who are experiencing breast-related symptoms such as lumps, pain, or changes in the breast tissue.
02
Individuals with a family history of breast cancer or other risk factors that warrant routine screening.
03
Patients who have been recommended for breast imaging by their healthcare provider as part of routine screening or to further investigate any abnormal findings.
04
Individuals who have undergone previous breast imaging and require follow-up studies to monitor changes or evaluate potential abnormalities.
05
Women who are at a higher risk of developing breast cancer due to genetic mutations or other factors may also require regular breast imaging.
Remember, it is always best to consult with a healthcare provider to determine if a breast imaging order form is needed and to discuss any specific concerns or recommendations.
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What is breast imaging order form?
The breast imaging order form is a document used to request and schedule imaging tests for breast health.
Who is required to file breast imaging order form?
Healthcare providers, radiologists, or physicians may be required to file the breast imaging order form.
How to fill out breast imaging order form?
The form should be filled out with patient information, type of imaging test requested, and any relevant medical history.
What is the purpose of breast imaging order form?
The purpose of the form is to ensure that the correct imaging tests are ordered and performed for the patient's breast health.
What information must be reported on breast imaging order form?
Patient demographics, reason for the test, type of imaging test, referring physician information, and any relevant medical history.
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