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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
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What is outside facility mammography exam?
Outside facility mammography exam is a mammography exam conducted at a facility outside of the patient's regular healthcare provider.
Who is required to file outside facility mammography exam?
The healthcare provider who conducted the outside facility mammography exam is required to file the 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 and the patient, and submitted according to the guidelines provided by the regulatory body.
What is the purpose of outside facility mammography exam?
The purpose of the outside facility mammography exam is to screen for and detect any abnormalities or signs of breast cancer in patients who have chosen to have their mammograms done outside of their regular healthcare provider's facility.
What information must be reported on outside facility mammography exam?
The outside facility mammography exam must include information about the patient, the facility where the exam was conducted, the healthcare provider who conducted the exam, the date of the exam, and any findings or recommendations from the exam.
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