Get the free PET-CT Requisition Form 11-6-15 ARTWORK
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Sinatra Martha Jefferson Hospital PET/CT Requisition Form Patient Label Medical Imaging Centralized Scheduling Phone (434) 6547130 Fax (434) 6548585 Please complete the following required information
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How to fill out pet-ct requisition form 11-6-15
How to fill out pet-ct requisition form 11-6-15:
01
First, fill out the patient's personal information section on the form. This includes their full name, date of birth, and contact information.
02
Next, provide the patient's medical history. This may include any relevant diagnoses, allergies, or previous surgeries.
03
Indicate the reason for the PET-CT scan by selecting the appropriate box or providing a brief description.
04
Specify any previous imaging studies or tests that have been done related to the current condition. Include the dates and results, if available.
05
If the patient has any implants or devices, such as pacemakers or metal plates, make sure to mention this in the relevant section.
06
Provide the referring physician's information, including their name, contact details, and signature.
07
If the patient has insurance coverage, complete the insurance information section, including the policy number and any pre-authorization requirements, if applicable.
08
Finally, review the completed form for accuracy and completeness before submitting it to the appropriate department.
Who needs pet-ct requisition form 11-6-15:
01
Patients who have been recommended for a PET-CT scan by their healthcare provider. This form is used to request the scan and provide necessary information for the procedure.
02
Healthcare professionals who are referring patients for a PET-CT scan. They need to fill out the requisition form to ensure that the appropriate tests are ordered and to provide relevant patient information to the imaging department.
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What is pet-ct requisition form 11-6-15?
The PET-CT requisition form 11-6-15 is a medical form used to request a PET-CT scan for a patient.
Who is required to file pet-ct requisition form 11-6-15?
The form is typically completed by a healthcare provider or physician who is requesting the PET-CT scan for a patient.
How to fill out pet-ct requisition form 11-6-15?
The form should be filled out with the patient's personal information, medical history, reason for the scan, and any relevant clinical details.
What is the purpose of pet-ct requisition form 11-6-15?
The purpose of the form is to provide necessary information for the healthcare provider to request a PET-CT scan for diagnostic or treatment purposes.
What information must be reported on pet-ct requisition form 11-6-15?
The form typically requires information such as patient demographics, clinical history, reason for the scan, relevant lab results, and any specific instructions.
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