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UK 108 Harley Street Radiology Request Form 2011-2025 free printable template

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RADIOLOGY REQUEST FORM Mammogram Breast Ultrasound X-Ray Ultrasound. Ii ilia civil. Created Date: 20111110150219Z ...
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How to fill out UK 108 Harley Street Radiology Request

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How to fill out UK 108 Harley Street Radiology Request Form

01
Start by filling in the patient's personal details, including name, date of birth, and contact information.
02
Provide the referring physician's details, including name, contact number, and practice address.
03
Indicate the type of radiology examination requested (e.g., X-ray, MRI, CT scan).
04
Include any specific clinical details or symptoms relevant to the patient's condition.
05
Fill in the area of the body to be examined explicitly.
06
Specify the urgency of the request (routine or urgent).
07
Sign and date the form before submission.
08
Ensure that all information is accurate and legible before handing the form to the patient or the medical facility.

Who needs UK 108 Harley Street Radiology Request Form?

01
Any healthcare professional who requires radiological imaging for diagnosis or treatment, including general practitioners, specialists, and hospitals.
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The UK 108 Harley Street Radiology Request Form is a standardized document used by healthcare professionals to request radiological imaging services for patients.
The form must be filled out and filed by authorized healthcare professionals, such as doctors or specialists, who seek radiological examinations for their patients.
To fill out the UK 108 form, a healthcare professional must provide patient details, specify the type of imaging required, include clinical information, and sign the request.
The purpose of the form is to ensure that radiology services are requested properly and that essential patient information is communicated to radiographers for accurate imaging and diagnosis.
The form must report the patient's personal details, referral details, clinical history, specific imaging requested, and the healthcare professional's signature.
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