Get the free Nuclear Medicine Requisition - Jewish General Hospital

Patient Identification Nuclear Medicine Requisition G19, Basement of Pavilion G 3755 CoteStCatherine Road Montreal, Quebec, H3T 1E2 Tel: 5143408222 ext. 5374 Fax: 5143407919 www.jgh.ca/nm Cardiovascular

How to fill out nuclear medicine requisition

How to fill out a nuclear medicine requisition:

Start by gathering all the necessary information:

1. The patient's full name and date of birth
2. The referring physician's name and contact information
3. The reason for the nuclear medicine test or procedure
4. Any specific instructions or requirements for the test

Complete the patient demographics section:

1. Fill in the patient's name, date of birth, gender, and contact information
2. Include any relevant identification numbers such as a medical record number or social security number

Provide the referring physician's information:

1. Enter the name, address, and contact details of the physician who has ordered the nuclear medicine test
2. Include their national provider identifier (NPI) number if required

Specify the type of nuclear medicine test or procedure:

1. Indicate the specific test or procedure being requested
2. Include any additional details such as the specific tracer or radiopharmaceutical to be used

Include any relevant clinical information:

This can include the patient's symptoms, medical history, or any other pertinent information that may impact the test or procedure

Indicate the desired date and time for the nuclear medicine test:

Provide options for when the test should be scheduled, taking into consideration any time constraints or the urgency of the test

Include any special instructions or requirements:

If there are any specific preparations the patient needs to follow before the test, such as fasting or avoiding certain medications, clearly state them on the requisition

Ensure all necessary signatures and authorizations are obtained:

The requisition may require the signatures of the referring physician and the ordering facility, depending on your institution's protocols

Who needs a nuclear medicine requisition?

Physicians ordering nuclear medicine tests:

1. Nuclear medicine requisitions are typically required by referring physicians who want to request specific diagnostic or therapeutic nuclear medicine procedures for their patients.
2. This ensures that the appropriate tests are ordered and performed, and the results are accurately interpreted by the nuclear medicine specialist.

Nuclear medicine technologists or radiologists:

1. Before conducting a nuclear medicine test, technologists or radiologists need the requisition to have all the necessary information about the patient, the requested test, and any specific instructions or requirements.
2. This ensures that the test is performed safely and accurately, and the results are properly documented and communicated.

Healthcare facilities or departments:

1. By having a requisition process in place, healthcare facilities or departments can efficiently manage the scheduling and coordination of nuclear medicine tests.
2. It also helps in maintaining records, billing purposes, and ensuring proper communication between the various involved parties.

Overall, a nuclear medicine requisition serves as an essential document to ensure the appropriate ordering, performance, and interpretation of nuclear medicine tests or procedures.

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What is nuclear medicine requisition?

Nuclear medicine requisition is a document that is used to request specific nuclear medicine procedures or tests.

Who is required to file nuclear medicine requisition?

Medical professionals such as doctors, radiologists, or nuclear medicine technologists are required to file nuclear medicine requisition.

How to fill out nuclear medicine requisition?

Nuclear medicine requisition can be filled out by providing patient information, test requested, reason for the test, and any other relevant information.

What is the purpose of nuclear medicine requisition?

The purpose of nuclear medicine requisition is to facilitate the scheduling and performance of specific nuclear medicine procedures for diagnostic or treatment purposes.

What information must be reported on nuclear medicine requisition?

Information such as patient's name, date of birth, medical history, test requested, reason for the test, and referring physician must be reported on nuclear medicine requisition.