WA Harrison Imaging Centers Diagnostic Imaging Order Form 2015-2026 free printable template

Harrison Imaging Centers Diagnostic Imaging Order Form Silver dale/Port Orchard Scheduling: (360) 3376500 Scheduling Fax: (360) 6625501 Polls/Bremerton Scheduling: (360) 4796555 Scheduling Fax: (360)

How to fill out WA Harrison Imaging Centers Diagnostic Imaging

How to fill out WA Harrison Imaging Centers Diagnostic Imaging Order

1. Obtain a blank Diagnostic Imaging Order form from WA Harrison Imaging Centers.
2. Fill out the patient's personal information at the top of the form including name, date of birth, and contact information.
3. Select the type of diagnostic imaging needed (e.g., X-ray, MRI, CT scan) by marking the appropriate box.
4. Provide any relevant clinical information that will assist the imaging center in understanding the reason for the procedure.
5. Indicate any specific instructions for the imaging, such as the preference for a certain technician or conditions that need to be met.
6. Include the referring physician's name and contact information.
7. Review the completed form for accuracy and completeness.
8. Sign and date the order if required.
9. Submit the completed order form to WA Harrison Imaging Centers via fax, email, or in person.

Who needs WA Harrison Imaging Centers Diagnostic Imaging Order?

1. Patients who require diagnostic imaging as directed by their healthcare provider.
2. Referring physicians who need to document the request for imaging services on behalf of their patients.
3. Insurance companies that may need the order for authorization and billing purposes.

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What is WA Harrison Imaging Centers Diagnostic Imaging Order?

The WA Harrison Imaging Centers Diagnostic Imaging Order is a formal request for diagnostic imaging services, such as X-rays, MRIs, and CT scans, intended to facilitate patient evaluations and treatments.

Who is required to file WA Harrison Imaging Centers Diagnostic Imaging Order?

Healthcare providers, such as physicians and specialists, are required to file the WA Harrison Imaging Centers Diagnostic Imaging Order to request imaging services for their patients.

How to fill out WA Harrison Imaging Centers Diagnostic Imaging Order?

To fill out the WA Harrison Imaging Centers Diagnostic Imaging Order, healthcare providers must provide patient information, specify the type of imaging needed, include relevant clinical information, and sign the order to authorize the procedure.

What is the purpose of WA Harrison Imaging Centers Diagnostic Imaging Order?

The purpose of the WA Harrison Imaging Centers Diagnostic Imaging Order is to provide a structured approach for healthcare providers to request necessary imaging services, ensuring that patients receive appropriate diagnostic evaluations.

What information must be reported on WA Harrison Imaging Centers Diagnostic Imaging Order?

The information that must be reported on the WA Harrison Imaging Centers Diagnostic Imaging Order includes patient demographics, the referring physician's details, the specific imaging requested, the clinical indication for the exam, and any relevant medical history.