Get the free Breast Imaging_DEXA Referral Form - Diagnostic Imaging Northwest
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This form is part of the patient s medical record and must be completed for referral Date of Referral — Referring Provider Name Patient Name (first, MI, last) D.O.B. — Patient Phone # () — (home)
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What is breast imaging_dexa referral form?
The breast imaging_dexa referral form is a document used to request a DEXA scan, which is a type of imaging test that measures bone density.
Who is required to file breast imaging_dexa referral form?
The referral form is typically completed by a healthcare provider, such as a physician or a specialist, who believes that a patient would benefit from a breast imaging_dexa scan.
How to fill out breast imaging_dexa referral form?
To fill out the breast imaging_dexa referral form, the healthcare provider will need to provide the patient's personal information, medical history, reason for the requested scan, and any additional relevant details.
What is the purpose of breast imaging_dexa referral form?
The purpose of the breast imaging_dexa referral form is to facilitate the request and scheduling of a DEXA scan for the evaluation of bone density, particularly in relation to potential osteoporosis or fracture risk.
What information must be reported on breast imaging_dexa referral form?
The breast imaging_dexa referral form typically requires the reporting of the patient's name, date of birth, contact information, relevant medical history, reason for the scan, and any supporting documentation or notes.
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