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WELCOME TO OUR OFFICE PLEASE COMPLETE ALL SECTIONS OF THIS INFORMATION FORM NAME: DOB: S.S.# RACE: ASIAN BLACK/AFRICAN AMERICAN CAUCASIAN ETHNICITY: HISPANIC/ LATINO AMERICAN INDIAN HISPANIC/ LATINO
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How to fill out interventional radiology patient registration
How to fill out interventional radiology patient registration?
01
Start by obtaining the interventional radiology patient registration form from the hospital or clinic where you will be receiving the procedure.
02
Fill in your personal information accurately, including your full name, address, date of birth, phone number, and email address.
03
Provide your medical history, including any previous surgeries, ongoing medical conditions, and current medications you are taking. It is important to be thorough and provide as much detail as possible to ensure proper care during the procedure.
04
Indicate any allergies or sensitivities you may have, especially if they are related to contrast agents or medications commonly used in interventional radiology procedures.
05
If applicable, provide information about your insurance coverage and bring any necessary insurance cards or documentation.
06
Read and sign any consent forms and disclosures provided, acknowledging that you understand the risks and benefits of the procedure.
07
Follow any additional instructions provided on the form, such as fasting requirements or medication adjustments prior to the procedure.
08
Submit the completed form to the hospital or clinic as instructed.
Who needs interventional radiology patient registration?
01
Patients who have been referred for an interventional radiology procedure by their primary care physician, specialist, or another healthcare provider.
02
Individuals who require diagnostic or therapeutic procedures that utilize image guidance, such as biopsies, angioplasty, embolization, or stent placement.
03
Patients with various medical conditions including vascular diseases, cancer, liver or kidney diseases, and uterine disorders, among others, who may benefit from interventional radiology procedures.
04
Any patient who is scheduled to undergo an interventional radiology procedure should complete the patient registration to ensure smooth coordination of care and accurate documentation of their medical history.
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