Get the free PET/CT Scan Scheduling Worksheet - UnityPoint Health

PET/CT (Use this form with approved diagnosis) St. Luke's Hospital Mercy Medical Center Name: Exam Date SS# DOB: MR# Act # Age: Sex: Height: Weight: Ordering Physician: Phone # where patient can be

How to fill out petct scan scheduling worksheet

How to fill out a PET/CT scan scheduling worksheet:

1. Start by obtaining the PET/CT scan scheduling worksheet from the designated healthcare provider or imaging center. This worksheet is typically given to patients who have been recommended for a PET/CT scan.
2. The worksheet will usually require basic personal information such as your full name, date of birth, contact information, and insurance details. Make sure to accurately fill in this information as it will be used for administrative purposes.
3. Next, the scheduling worksheet may ask for your referring physician's information. This includes the name, address, phone number, and any special instructions from the physician pertaining to the scan.
4. Some worksheets may require information regarding your medical history and current health status. This is important for the radiology team to evaluate your suitability for the scan and to take necessary precautions.
5. The scheduling worksheet will usually have a section where you can indicate your preferred date and time for the PET/CT scan. It may also provide alternative options if your preferred choice is not available.
6. In case you have any known allergies or medical conditions that may affect the scan or contrast agents used, ensure to mention it in the appropriate section of the worksheet. This helps the medical team to tailor the procedure accordingly.
7. Additionally, the worksheet may require you to provide information about any medications you are currently taking. Include the name, dosage, and frequency of each medication as this can impact the scan protocol.
8. Finally, carefully review all the information you have entered on the PET/CT scan scheduling worksheet to make sure it is accurate and complete. If you have any doubts or questions, don't hesitate to reach out to the healthcare provider or imaging center for clarification.

Who needs a PET/CT scan scheduling worksheet?

1. Patients who have been recommended for a PET/CT scan by their physician require a scheduling worksheet. This is typically provided by the healthcare provider or imaging center.
2. The scheduling worksheet is important for the administrative staff to gather necessary information, plan the scan, and coordinate the appointment.
3. It is also beneficial for the radiology team to have a comprehensive understanding of the patient's medical history, medications, allergies, and any other relevant details before performing the PET/CT scan.
4. Overall, the PET/CT scan scheduling worksheet is a valuable tool that ensures a smooth and organized process for both the healthcare provider and the patient.

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What is petct scan scheduling worksheet?

The PET/CT scan scheduling worksheet is a form used to schedule a positron emission tomography/computerized tomography scan for patients.

Who is required to file petct scan scheduling worksheet?

The healthcare provider or facility conducting the PET/CT scan is required to file the scheduling worksheet.

How to fill out petct scan scheduling worksheet?

The PET/CT scan scheduling worksheet is filled out by providing information such as patient details, medical history, reason for scan, and scheduling preferences.

What is the purpose of petct scan scheduling worksheet?

The purpose of the PET/CT scan scheduling worksheet is to facilitate the scheduling process for the scan and ensure all necessary information is gathered.

What information must be reported on petct scan scheduling worksheet?

The PET/CT scan scheduling worksheet must include patient demographics, medical history, current medications, reason for scan, and preferred scheduling dates.