Get the free Colorado Region X-Ray Order form - Kaiser Permanente ... - providers kaiserpermanente
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ORDERING/REFERRING CLINICIAN (Please print): ... Sign Or SymptomNecessitating The Reason For The Visit Must Be Provided Before Rendering The Service): ... 02/09 Radiology ... Today's date: REGIONAL
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How to fill out colorado region x-ray order
How to fill out Colorado region x-ray order:
01
Start by gathering the necessary information. You will need the patient's name, contact information, and date of birth. Additionally, you will need the referring physician's name and the reason for the x-ray order.
02
Fill out the patient information section on the order form. Enter the patient's full name, address, phone number, and date of birth accurately.
03
Provide the referring physician's information in the appropriate section. Include the physician's full name, clinic or hospital name, address, and contact number.
04
Specify the reason for the x-ray order in the designated field. This could include symptoms, injury details, or any other relevant information that justifies the need for an x-ray.
05
Indicate the type of x-ray required, such as a specific body part or region, in the appropriate section. Be as specific as possible to ensure accurate imaging.
06
Fill in the date and time for the x-ray appointment if it has already been scheduled. If not, leave this section blank for the imaging facility to complete.
07
Review the completed form for any errors or missing information. Make sure that all fields are properly filled out before submitting the order.
Who needs Colorado region x-ray order?
01
Patients who have been referred by a physician for diagnostic purposes may require a Colorado region x-ray order.
02
Individuals who have experienced an injury or are experiencing symptoms that may require a radiographic examination may need a Colorado region x-ray order.
03
Medical professionals, such as doctors, orthopedic specialists, and other healthcare providers, may need a Colorado region x-ray order to guide their diagnosis and treatment decisions.
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