Get the free Outside Facility Mammography Exam Request Form Date: - lahey

41 Mall Road Burlington, MA 01805 781.744.5100 P lava.org Outside Facility Mammography Exam Request Form Date: Name of Outside Facility Address Phone# Fax# The following patient DOB: LC# is requesting

How to fill out outside facility mammography exam

How to fill out outside facility mammography exam:

1. Start by obtaining the necessary forms from the outside facility where you will be getting the mammography exam. These forms usually include a patient information form and a consent form.
2. Read through the forms carefully and provide accurate and complete information. Fill in your personal details such as name, date of birth, contact information, and any relevant medical history.
3. Ensure that you understand the questions on the forms. If you have any doubts or concerns, don't hesitate to ask the staff at the outside facility for clarification.
4. Sign the consent form after you have carefully read and understood the information provided. This form gives your permission for the mammography exam to be conducted.
5. Schedule an appointment for the mammography exam at the outside facility. Take note of the date, time, and location of the appointment.
6. Prepare for the exam by following any specific instructions given by the outside facility. This may include avoiding the use of deodorants, lotions, or powders on the day of the exam.
7. On the day of the exam, arrive at the outside facility on time and bring any necessary documentation, such as your identification and insurance information.
8. Follow the instructions provided by the healthcare professionals at the outside facility during the exam. They will guide you through the necessary steps to ensure accurate and reliable results.
9. After the exam, inquire about the process for receiving your results. This may include waiting for a certain period of time or scheduling a follow-up appointment with your healthcare provider.
10. Keep a copy of the completed forms for your records, as they may be required for future reference or when coordinating with your primary healthcare provider.

Who needs outside facility mammography exam?

1. Women who require specialized mammography services that are not available at their regular healthcare facility may need an outside facility mammography exam.
2. Individuals who have been referred to a specific outside facility by their primary healthcare provider for a mammography exam need to have the exam performed at that facility.
3. Some insurance plans or healthcare policies may require individuals to have mammography exams done at specific outside facilities for coverage purposes. In such cases, individuals would need to go to the designated facilities for their mammography exams.

For pdfFiller’s FAQs

How can I send outside facility mammography exam for eSignature?

Once your outside facility mammography exam is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.

Can I create an eSignature for the outside facility mammography exam in Gmail?

You can easily create your eSignature with pdfFiller and then eSign your outside facility mammography exam directly from your inbox with the help of pdfFiller’s add-on for Gmail. Please note that you must register for an account in order to save your signatures and signed documents.

How do I edit outside facility mammography exam on an iOS device?

Yes, you can. With the pdfFiller mobile app, you can instantly edit, share, and sign outside facility mammography exam on your iOS device. Get it at the Apple Store and install it in seconds. The application is free, but you will have to create an account to purchase a subscription or activate a free trial.