Canada Alberta Health Services Lumbar Spine Imaging Screening Record 2017-2025 free printable template
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Patient label here or information below is required Last Name First Name Birthdate Lumbar Spine Imaging Screening Record Gender yyyy-Mon-dd Personal Health Number Daytime Phone The following information is required in order for us to process your request for lumbar spine imaging. Patient Age Referring Physician Print first and last name Was an MRI or CT recommended on a previous imaging report Yes include a copy of the report No In suspected disc herniation or spinal stenosis are symptoms...
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How to fill out Canada Alberta Health Services Lumbar Spine Imaging
01
Obtain the Alberta Health Services Lumbar Spine Imaging requisition form from your healthcare provider or download it online.
02
Fill in patient identification details, including name, date of birth, and health care number.
03
Indicate the specific imaging procedure required, such as X-ray, MRI, or CT scan.
04
Provide relevant clinical history and symptoms prompting the imaging request.
05
Review any necessary pre-imaging instructions specific to the procedure.
06
Sign and date the requisition form as required.
07
Submit the completed form to the appropriate imaging department or clinic.
Who needs Canada Alberta Health Services Lumbar Spine Imaging?
01
Individuals experiencing lower back pain or discomfort.
02
Patients with symptoms of nerve compression, such as numbness or weakness in the legs.
03
People who have sustained an injury affecting the lumbar spine.
04
Patients being assessed for conditions such as herniated discs, spinal stenosis, or other spinal abnormalities.
05
Individuals with chronic back issues requiring further evaluation.
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What is Canada Alberta Health Services Lumbar Spine Imaging?
Canada Alberta Health Services Lumbar Spine Imaging refers to diagnostic imaging procedures performed to evaluate the lumbar spine, typically involving techniques like X-rays, MRI, or CT scans to assess conditions affecting the lower back region.
Who is required to file Canada Alberta Health Services Lumbar Spine Imaging?
Healthcare providers, such as doctors or specialists, are required to file for Canada Alberta Health Services Lumbar Spine Imaging when they determine that imaging is necessary for diagnosing or monitoring a patient's lumbar spine condition.
How to fill out Canada Alberta Health Services Lumbar Spine Imaging?
To fill out Canada Alberta Health Services Lumbar Spine Imaging forms, providers should complete sections detailing patient information, specific imaging requested, clinical indications for the imaging, and any relevant medical history.
What is the purpose of Canada Alberta Health Services Lumbar Spine Imaging?
The purpose of Canada Alberta Health Services Lumbar Spine Imaging is to provide accurate assessments of the lumbar spine to aid in diagnosing conditions, guide treatment plans, and monitor the progression of spinal issues.
What information must be reported on Canada Alberta Health Services Lumbar Spine Imaging?
Information that must be reported includes patient demographics, specific symptoms or conditions leading to the imaging request, previous treatments or imaging results related to the lumbar spine, and the physician's clinical impression.
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