Get the free Outside Facility Mammography Film Request - lahey

Outside Facility Mammography Film Request Form Date: Name of Outside Facility Address Phone# Fax# The following patient DOB: LC# is requesting their mammogram films be sent to the facility listed

How to fill out outside facility mammography film

How to fill out outside facility mammography film:

1. Begin by writing the patient's name and date of birth at the top of the form. This ensures proper identification and organization.
2. Fill in the referring physician's name and contact information. This information is important for communication and follow-up purposes.
3. Record the patient's medical history, including any relevant past medical conditions or surgeries. This allows the radiologist to have a comprehensive understanding of the patient's health.
4. Provide the reason for the mammography exam and indicate any specific areas or symptoms of concern. This helps guide the radiologist's interpretation and focus.
5. Note any previous mammogram dates and results, if applicable. This provides a reference for comparison and tracking of changes over time.
6. Specify the type of imaging requested, whether it is a standard mammogram or a specialized procedure such as a diagnostic mammogram or breast ultrasound.
7. Indicate the patient's breast density, if known. Breast density can impact the visibility of abnormalities on mammograms and may require additional imaging techniques.
8. Include the contact information of the outside facility where the mammogram was performed. This is essential for the radiologist to obtain the images and any additional information if necessary.

Who needs outside facility mammography film:

1. Patients who require a second opinion or further evaluation may need outside facility mammography film. This may be recommended if the initial mammogram results are inconclusive or if there is a need for specialized expertise.
2. Individuals who have received care from multiple healthcare providers or facilities may require outside facility mammography film. This ensures that all relevant medical information is accessible to the radiologist for accurate interpretation and decision-making.
3. Patients who have relocated or are seeking medical care in a different region may need outside facility mammography film. This enables the new healthcare provider to have access to previous imaging records and provide appropriate care based on the patient's history.

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What is outside facility mammography film?

Outside facility mammography film refers to mammography films taken outside the main facility where the patient's regular healthcare provider is located.

Who is required to file outside facility mammography film?

The healthcare provider or facility that conducted the mammography outside the main facility is required to file the outside facility mammography film.

How to fill out outside facility mammography film?

To fill out the outside facility mammography film, the healthcare provider must provide all required information, including patient's details, date and location of the mammography, and any findings.

What is the purpose of outside facility mammography film?

The purpose of outside facility mammography film is to ensure that all mammography results are documented and accessible for the patient's healthcare provider.

What information must be reported on outside facility mammography film?

The outside facility mammography film must include patient's details, date and location of the mammography, findings, and contact information of the healthcare provider or facility.