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APPOINTMENT DATE APPOINTMENT TIME AM/PM SCHEDULING INFORMATION Phone: 860.714.2RAH (2724) Fax: 860.714.8808 www.rahxray.com Avon 35 Nod Rd. Suite 101 Early, Late and Saturday Hours available. Patient
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How to fill out requisition radiology order form

01
Step 1: Start by obtaining a blank requisition radiology order form from the appropriate medical facility.
02
Step 2: Fill out the patient's personal information including their full name, date of birth, and contact details.
03
Step 3: Provide the referring physician's name, address, and contact information.
04
Step 4: Specify the type of radiology study or test that is being requested.
05
Step 5: Indicate any specific instructions or clinical information that the radiologist should be aware of.
06
Step 6: Fill in the insurance information, including the policy number and any required authorization codes.
07
Step 7: Review the completed form for accuracy and legibility.
08
Step 8: Sign and date the requisition radiology order form.
09
Step 9: Submit the form to the appropriate radiology department or facility as per their specific instructions.

Who needs requisition radiology order form?

01
Requisition radiology order forms are needed by healthcare professionals, such as doctors, surgeons, and referring physicians, who require diagnostic imaging services for their patients.
02
These forms are also necessary for patients who are scheduled to undergo radiology studies or tests as it serves as an official request for the specific procedure.
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The requisition radiology order form is a document used to request specific radiology tests or procedures for a patient.
Healthcare providers, such as physicians or nurse practitioners, are required to file the requisition radiology order form.
To fill out the requisition radiology order form, the healthcare provider must provide patient information, the type of radiology test needed, and any relevant medical history.
The purpose of the requisition radiology order form is to ensure that the correct radiology tests are performed on the patient.
The requisition radiology order form must include patient demographics, medical history, the type of radiology test needed, and the ordering provider's information.
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