Get the free BImagingb Order bRequest Formb - Seton bImagingb Center

Imaging Order Request 3449 Wilkens Ave., Suite 102, Baltimore, MD 212295299 667.234.8675 phone 667.234.8688 fax www.setonimagingcenter.com Patient Name: Appointment Date & Time: Ordering Physician:

How to fill out bimagingb order brequest formb

How to fill out an imaging order request form:

1. Begin by providing your personal information such as your full name, contact number, and address. This information is necessary for the healthcare facility to communicate with you regarding the imaging appointment and results.
2. Specify the type of imaging test you are requesting. This could be an X-ray, MRI, CT scan, ultrasound, or any other imaging modality that is applicable to your medical condition. If you are not sure which test you need, consult your healthcare provider for guidance.
3. Indicate the reason for the imaging request. Describe your symptoms or medical condition that necessitate the need for this specific test. Be as detailed as possible to help the imaging department understand your situation better.
4. Mention any relevant medical history or previous imaging studies performed. This information assists the radiologist or radiology technician in accurately interpreting your test results and making informed decisions about your care.
5. Provide details about your healthcare provider or the physician who ordered the imaging study. Include their name, contact information, and any specific instructions they have given you regarding the test.
6. If applicable, mention any allergies or medications you are currently taking. This information is crucial for the imaging facility to ensure your safety and avoid any adverse reactions during the procedure.
7. Include your insurance information, if applicable. Provide your insurance provider's name, policy number, and any required authorization or referral forms. This will help facilitate smooth billing and insurance claims processing.

Who needs an imaging order request form?

1. Patients who require specialized medical imaging to diagnose or monitor their medical conditions.
2. Healthcare providers who order imaging tests for their patients to aid in diagnosis, treatment planning, or tracking the progress of a medical condition.
3. Radiology departments or imaging centers responsible for scheduling and performing the requested imaging tests.

For pdfFiller’s FAQs

What is bimagingb order brequest formb?

The imaging order request form is a document used to request imaging services such as X-rays, MRIs, CT scans, etc.

Who is required to file bimagingb order brequest formb?

Medical professionals, such as doctors or radiologists, are required to file imaging order request forms for patients.

How to fill out bimagingb order brequest formb?

The form typically requires basic information about the patient, the type of imaging needed, and relevant medical history.

What is the purpose of bimagingb order brequest formb?

The purpose of the form is to provide necessary information for medical imaging services to be performed accurately and safely.

What information must be reported on bimagingb order brequest formb?

The form usually requires details about the patient's identity, the specific imaging study required, and any relevant medical conditions or contraindications.

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