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

16 Hayden Avenue Lexington, MA 02421 781.372.7035 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 an outside facility mammography exam:

1. Contact the outside facility: Begin by calling or visiting the outside facility where you intend to have the mammography exam. Inquire about their specific requirements and scheduling options.
2. Obtain and complete necessary forms: The outside facility may provide you with various forms that need to be filled out prior to the exam. These forms typically include personal information, medical history, and consent forms. Ensure that you carefully read and accurately complete all the required sections.
3. Gather relevant medical records: If you have any previous mammography results or relevant medical records, it is advisable to bring them to the outside facility. This can help provide a comprehensive view of your medical history and aid in the accuracy of the exam.
4. Ensure insurance coverage and authorizations: Contact your insurance provider to ensure coverage for the outside facility mammography exam. In some cases, prior authorization may be required. Make sure to follow the necessary steps to obtain approval, if needed.
5. Schedule the mammography exam: Coordinate with the outside facility to schedule a mutually convenient time and date for your mammography exam. Take note of any specific preparation guidelines provided by the facility, such as avoiding certain lotions or deodorants prior to the exam.

Who needs an outside facility mammography exam:

1. Individuals with limited access to local mammography facilities: Some people may live in areas where there are no nearby mammography facilities or have limited access to them. In such cases, visiting an outside facility becomes necessary to ensure timely and accurate screening.
2. Diagnostic follow-up for abnormal mammogram results: If your routine mammogram shows abnormal findings, your healthcare provider may refer you to an outside facility for further diagnostic tests or a second opinion. It is essential to follow through with these recommendations to facilitate appropriate medical care.
3. Seeking specialized expertise or equipment: Certain outside facilities may have specialized expertise or advanced equipment that may not be available at your local mammography center. This can be particularly relevant in cases where specific concerns or medical conditions require specialized attention or technology.

Please consult with your healthcare provider for a personalized assessment of your mammography needs and recommendations for an outside facility exam.

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What is outside facility mammography exam?

Outside facility mammography exam is a mammography screening conducted at a facility that is not the patient's regular healthcare provider.

Who is required to file outside facility mammography exam?

The facility where the mammography exam was conducted is required to file the outside facility mammography exam.

How to fill out outside facility mammography exam?

The outside facility mammography exam should be filled out with all relevant information about the exam, including the date, facility name, patient information, and results.

What is the purpose of outside facility mammography exam?

The purpose of the outside facility mammography exam is to ensure that patients receive proper screenings at reputable facilities to detect any potential issues early on.

What information must be reported on outside facility mammography exam?

Information such as patient demographics, exam date, facility information, and exam results must be reported on the outside facility mammography exam.