Get the free PETCT EXAM REQUEST FORM - bclaremontimagingbbcomb
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Location: 255 E. Bonita Ave., Bldg. 3A Pomona, CA 91769 All contracts are listed under: Claremont Imaging Associates 200236047 www.claremontimaging.com (Located in the Kit tell Building) www.casacolina.org
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How to fill out petct exam request form
How to fill out a PET/CT exam request form:
01
Gather all necessary information: Before starting to fill out the PET/CT exam request form, make sure you have all the required information. This may include the patient's name, date of birth, contact information, referring physician's details, medical history, and any relevant test results.
02
Identify the purpose of the exam: Determine why the PET/CT exam is being requested. It could be for cancer diagnosis, staging, treatment planning, or monitoring response to treatment. Clearly state the reason for the exam in the appropriate section of the form.
03
Select the appropriate examination type: PET/CT exams can vary based on the specific procedure required. Choose the correct examination type from the options provided on the form. This could include whole-body imaging, dedicated brain scan, or specific organ evaluation.
04
Provide clinical indications: In this section, describe the clinical symptoms or findings that necessitate the PET/CT exam. Mention any specific concerns, suspected diagnoses, or areas of interest.
05
Include any relevant patient history: Document the patient's medical history, including previous illnesses, surgeries, ongoing treatments, or allergies that may influence the interpretation of the PET/CT results.
06
Add details about prior imaging studies: If the patient has undergone any previous imaging studies, such as CT scans or X-rays, mention them in this section. Include the dates, types of exams, and any pertinent findings.
07
Provide a list of current medications: It is essential to list all medications the patient is currently taking, including over-the-counter drugs, supplements, or herbal remedies. This information helps the interpreting physician evaluate any potential interactions or side effects during the exam.
08
Referencing the referring physician: Clearly state the name and contact details of the physician requesting the PET/CT exam. This ensures effective communication and reporting of the results.
Who needs a PET/CT exam request form?
01
Referring physicians: General practitioners, oncologists, surgeons, or other healthcare professionals may need to request a PET/CT exam for their patients as part of the diagnostic or treatment process.
02
Patients undergoing cancer evaluation: Individuals who are suspected or confirmed to have cancer may require a PET/CT exam to determine the extent of the disease, assess treatment response, or aid in treatment planning.
03
Medical imaging specialists: Radiologists, nuclear medicine physicians, or technologists involved in conducting PET/CT exams may also need to fill out the exam request form to ensure accurate and appropriate imaging procedures are performed.
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What is petct exam request form?
The PETCT exam request form is a document used to request a PETCT scan for medical imaging purposes.
Who is required to file petct exam request form?
Patients who have been referred by their healthcare provider for a PETCT scan are required to file the PETCT exam request form.
How to fill out petct exam request form?
To fill out the PETCT exam request form, patients need to provide their personal information, medical history, reason for the scan, and any relevant insurance information.
What is the purpose of petct exam request form?
The purpose of the PETCT exam request form is to authorize the medical facility to perform a PETCT scan on the patient.
What information must be reported on petct exam request form?
The PETCT exam request form must include the patient's name, date of birth, medical history, reason for the scan, insurance information, and referring healthcare provider.
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