Get the free DEXA Request Form - Circle Partnership - circlehealth co

DEXA Request Form Circlet Fox cote Avenue Shakedown St John Bath BA2 8SQ T: 0808 188 1880 F: 01761 422223 Bone Density Appointments Telephone: 01761 422255 Fax: 01761 422233 Date: Time: Patient Name

How to fill out dexa request form

How to fill out a dexa request form:

1. Begin by obtaining the dexa request form from the appropriate healthcare provider or institution. This form may be available online or through a medical office.
2. Make sure to read the instructions provided on the form carefully. This will ensure that you provide all the necessary information and fill out the form correctly.
3. Start by entering your personal information, including your full name, date of birth, address, and contact information. This information is crucial for accurately identifying and contacting you for the test results.
4. Next, provide details about your referring healthcare provider. This typically includes their name, specialty, and contact information. It's important to ensure that this information is accurate to facilitate communication between the provider and the testing facility.
5. Indicate the reason for the dexa scan request. The form may provide checkboxes or options to select the appropriate indication, such as osteoporosis evaluation or monitoring bone density changes.
6. If you have any relevant medical history or conditions that may be pertinent to the dexa scan, ensure to provide these details. This can include previous fractures, hormone therapy, or any other relevant medical factors.
7. Provide your insurance information if required. This may include the name of your insurance company, policy number, and any other relevant details. If you do not have insurance, inquire about self-pay options or any financial assistance programs available.
8. Finally, review the completed form for any errors or missing information before submitting it. Ensure that all required fields have been filled out accurately and legibly.
9. Return the completed dexa request form to the appropriate healthcare provider or institution as instructed. Follow any additional steps indicated, such as scheduling an appointment for the scan.

Who needs a dexa request form:

1. Individuals who have been recommended by their healthcare provider for a dexa scan to assess bone density or evaluate osteoporosis.
2. Patients who have certain risk factors for bone loss, such as postmenopausal women, individuals with a family history of osteoporosis, or those who have experienced previous fractures.
3. People undergoing treatment that may affect bone health, such as long-term steroid use or hormonal therapy, may also require a dexa scan.

It's essential to consult with a healthcare provider to determine if a dexa scan is necessary and if a dexa request form needs to be completed.

For pdfFiller’s FAQs

What is dexa request form?

The dexa request form is a form used to request a dual-energy X-ray absorptiometry (DEXA) scan for bone density testing.

Who is required to file dexa request form?

Patients who have been prescribed a DEXA scan by their healthcare provider are required to file the dexa request form.

How to fill out dexa request form?

To fill out the dexa request form, you need to provide your personal information, healthcare provider's information, reason for the DEXA scan, and any relevant medical history.

What is the purpose of dexa request form?

The purpose of the dexa request form is to request a DEXA scan for bone density testing in order to assess the risk of osteoporosis or bone fractures.

What information must be reported on dexa request form?

The dexa request form must include personal information, healthcare provider's information, reason for the DEXA scan, and any relevant medical history.

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