Get the free Lumbar Puncture Requisition - Southwest Diagnostic Imaging Center

LUMBAR PUNCTURE REQUISITION Patient Name: Date of Birth: Patient Phone (Day): (Eve): (Cell): Physician: Phone: Physician Signature: Exam Comments: Clinical Information×Diagnosis: Opening Pressure

How to fill out lumbar puncture requisition

How to fill out a lumbar puncture requisition:

1. Start by writing your full name and contact information at the top of the requisition form. This ensures that the test results can be correctly attributed to you.
2. Next, provide your date of birth and gender. This information is important for accurate identification and matching of medical records.
3. Indicate the reason for the lumbar puncture by clearly stating the symptoms or medical condition that warrant the procedure. This helps the healthcare professionals determine the appropriate course of action.
4. Specify any relevant medical history or pre-existing conditions that may impact the procedure or its results. This includes allergies, ongoing medications, or previous lumbar puncture experiences.
5. If applicable, provide the referring physician's name, contact information, and any additional notes or instructions they may have given for the test.
6. Include your insurance information, if required. This ensures that the cost of the lumbar puncture is correctly billed to your insurance provider and prevents any delays in processing.
7. Finally, sign and date the requisition form to validate the information provided and acknowledge your consent for the procedure.

Who needs a lumbar puncture requisition:

1. Patients who present with symptoms or medical conditions that may indicate neurological disorders or infections may require a lumbar puncture. This includes individuals experiencing severe headaches, meningitis, encephalitis, or suspected cases of multiple sclerosis.
2. Individuals who have been referred by their primary care physician or a specialist for further investigation and diagnosis may also need a lumbar puncture requisition. This is often done to rule out or confirm specific medical conditions.
3. Patients who are undergoing treatment for certain diseases, such as cancer or autoimmune disorders, may require a lumbar puncture as part of their ongoing monitoring and management.

In all cases, the decision to perform a lumbar puncture and the need for a requisition form will be made by a healthcare professional based on their assessment of the patient's medical history, symptoms, and suspected conditions.

For pdfFiller’s FAQs

What is lumbar puncture requisition?

Lumbar puncture requisition is a form that is used to request a lumbar puncture procedure, also known as a spinal tap, to collect cerebrospinal fluid for diagnostic testing.

Who is required to file lumbar puncture requisition?

A healthcare provider or a physician is required to file a lumbar puncture requisition.

How to fill out lumbar puncture requisition?

To fill out a lumbar puncture requisition, the healthcare provider needs to provide patient information, clinical history, reason for the procedure, and any relevant test orders.

What is the purpose of lumbar puncture requisition?

The purpose of a lumbar puncture requisition is to request a diagnostic procedure to help diagnose conditions affecting the central nervous system.

What information must be reported on lumbar puncture requisition?

Information such as patient demographics, clinical history, referring physician, reason for the procedure, and any specific test requests must be reported on a lumbar puncture requisition.

How do I make edits in lumbar puncture requisition without leaving Chrome?

Install the pdfFiller Chrome Extension to modify, fill out, and eSign your lumbar puncture requisition, which you can access right from a Google search page. Fillable documents without leaving Chrome on any internet-connected device.

How do I edit lumbar puncture requisition straight from my smartphone?

The easiest way to edit documents on a mobile device is using pdfFiller’s mobile-native apps for iOS and Android. You can download those from the Apple Store and Google Play, respectively. You can learn more about the apps here. Install and log in to the application to start editing lumbar puncture requisition.

How do I edit lumbar puncture requisition on an iOS device?

Use the pdfFiller mobile app to create, edit, and share lumbar puncture requisition from your iOS device. Install it from the Apple Store in seconds. You can benefit from a free trial and choose a subscription that suits your needs.