UW Medicine Radiology Order Form free printable template
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RADIOLOGY ORDER FORM UW Medicine SCHEDULING: 2065987200 FAX: 2065987690 ESC RADIOLOGY TECHNOLOGIST: 2065986761 (for urgent use only) PATIENT INFORMATION EASTSIDE SPECIALTY CENTER REFERRING PROVIDER
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How to fill out UW Medicine Radiology Order Form
01
Start by downloading the UW Medicine Radiology Order Form from the official website or obtain a physical copy from your healthcare provider.
02
Fill in the patient's demographic information, including name, date of birth, and medical record number, if applicable.
03
Specify the referring physician's information, including name, contact number, and practice location.
04
Indicate the type of radiology service required (e.g., MRI, CT scan, X-ray) by checking the appropriate box.
05
Provide a brief description of the clinical indication for the radiology order, including relevant symptoms and findings.
06
Include any necessary clinical history that may assist in the imaging process.
07
Note any specific instructions or preparations needed for the patient before the imaging study.
08
Sign and date the form before submission to ensure it is valid.
09
Submit the completed form to the radiology department as instructed, either electronically or in person.
Who needs UW Medicine Radiology Order Form?
01
The UW Medicine Radiology Order Form is needed by healthcare providers who are referring patients for radiological imaging services.
02
Patients may need to engage with the form indirectly as it is required for their imaging procedures.
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What is UW Medicine Radiology Order Form?
The UW Medicine Radiology Order Form is a document used by healthcare providers to request radiology services for patients within the UW Medicine system.
Who is required to file UW Medicine Radiology Order Form?
Healthcare providers, such as physicians and authorized medical staff, are required to file the UW Medicine Radiology Order Form when referring patients for radiology services.
How to fill out UW Medicine Radiology Order Form?
To fill out the UW Medicine Radiology Order Form, providers must complete patient information, specify the requested radiology examinations, provide clinical indications, and sign the form before submission.
What is the purpose of UW Medicine Radiology Order Form?
The purpose of the UW Medicine Radiology Order Form is to ensure accurate communication between the referring provider and the radiology department regarding the patient’s examination needs.
What information must be reported on UW Medicine Radiology Order Form?
The information that must be reported includes the patient's demographic details, the type of radiology exam requested, clinical history, and relevant symptoms or conditions.
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