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PET/CT Patient Screening Form Part A Patient Label Pt. Name (Last, First): Date of Birth: Sex: Medical Record #: Patient Stated Weight: Height: Facility Name: Pt. Address: Date of Exam: Exam Ordered:

How to fill out pet-ct screening form

How to fill out a PET-CT screening form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and any specific requirements or guidelines mentioned.
2. Begin by filling out your personal information accurately. This typically includes your full name, date of birth, contact information, and any relevant identification numbers or medical record numbers.
3. Provide information about your medical history. This may involve answering questions related to any existing medical conditions, allergies, surgeries, or medications you are currently taking.
4. Answer questions regarding your current health status. You may be asked about symptoms you are experiencing, recent illnesses or infections, or any changes in your overall well-being.
5. If applicable, provide details about your smoking history. PET-CT scans are often used to detect lung cancer, and smoking history can be a significant factor in assessing the risk.
6. Mention any recent diagnostic tests or imaging studies you have undergone that are relevant to the PET-CT screening. This can help the healthcare provider assess the need for the scan and interpret the results accurately.
7. Indicate if you have any known allergies, especially to contrast agents used in the scan. PET-CT scans often involve the administration of radioactive substances and contrast agents, so it's crucial to inform the medical staff about any allergies or adverse reactions you may have had in the past.
8. Finally, sign and date the form to validate your responses. By doing so, you acknowledge that the information provided is true and accurate to the best of your knowledge.

Who needs a PET-CT screening form?

1. Individuals who are suspected of having abnormalities or diseases that could be detected through a PET-CT scan may need to fill out a screening form. This includes individuals with suspected cancer, certain neurological disorders, or cardiovascular diseases, among others.
2. Patients who have been referred to a PET-CT scan by their doctors or healthcare providers will typically be required to complete a screening form. This helps ensure that the scan is appropriate and safe for the individual, taking into account any potential risks or contraindications.
3. It is important to note that the decision to use a PET-CT scan and the requirement for a screening form may vary depending on the healthcare facility, the specific medical condition being investigated, and the guidelines set by the medical professionals involved in the diagnostic process.

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What is pet-ct screening form?

PET-CT screening form is a form used to gather information about a patient's medical history and current health status before undergoing a PET-CT scan.

Who is required to file pet-ct screening form?

Patients who are scheduled to undergo a PET-CT scan are required to fill out the screening form.

How to fill out pet-ct screening form?

Patients can fill out the PET-CT screening form by providing accurate information about their medical history, current medications, and any existing health conditions.

What is the purpose of pet-ct screening form?

The purpose of the PET-CT screening form is to ensure that the patient is healthy enough to undergo the scan and to identify any potential risks or contraindications.

What information must be reported on pet-ct screening form?

The PET-CT screening form typically asks for information about the patient's medical history, current medications, allergies, and any existing health conditions.