Get the free I-131 Treatment Scheduling Form - Division of Nuclear Medicine - gamma wustl

Mallinckrodt Institute of Radiology Barnes-Jewish Hospital PHYSICIAN REQUEST FORM FOR RADIOIODINE UPTAKE AND/OR TREATMENT Instructions: Fax completed form to (314) 362-0414. We will call back with

How to fill out i-131 treatment scheduling form

How to fill out the i-131 treatment scheduling form:

1. Start by carefully reading the instructions provided with the form. Make sure you understand the purpose of the form and the information required.
2. Begin filling out the form by entering your personal details in Section 1. This includes your full name, address, date of birth, and contact information.
3. In Section 2, provide your USCIS online account number, if applicable. If you don't have an online account, leave this section blank.
4. Move on to Section 3 and select the appropriate box that corresponds to your eligibility for filing the form. Depending on your situation, you may need to attach additional evidence or supporting documents. Follow the instructions provided to ensure you include all necessary information.
5. Next, in Section 4, indicate the type of benefit you are seeking by checking the appropriate box. For the i-131 treatment scheduling form, you will typically select "Application for Travel Document."
6. In Section 5, provide details about your proposed travel plans. This includes the dates of departure and return, destination country, and purpose of travel.
7. If you have any special circumstances or additional information you would like to include, use Section 6 to provide those details.
8. Review the completed form thoroughly, ensuring that you have filled in all the required fields and signed in the designated area.
9. Prepare any supporting documents you need to include with the form, such as proof of medical treatment or supporting letters.
10. Make a copy of the completed form and all supporting documents for your records.
11. Finally, submit the i-131 treatment scheduling form and supporting documents to the appropriate USCIS address provided in the instructions.

Who needs the i-131 treatment scheduling form:

1. Individuals who require a travel document for medical treatment purposes and have already obtained or are in the process of obtaining an Advance Parole.
2. Foreign nationals who are applying for re-entry to the United States after traveling abroad for medical treatment.
3. U.S. citizens who are sponsoring the medical treatment of a foreign national and need to apply for a travel document on their behalf to facilitate the process.

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What is i-131 treatment scheduling form?

The i-131 treatment scheduling form is a document used to schedule treatment involving the radioactive isotope i-131.

Who is required to file i-131 treatment scheduling form?

Patients who are undergoing treatment involving i-131 are required to file the scheduling form.

How to fill out i-131 treatment scheduling form?

To fill out the i-131 treatment scheduling form, patients must provide their personal information, treatment details, and scheduling preferences.

What is the purpose of i-131 treatment scheduling form?

The purpose of the i-131 treatment scheduling form is to help healthcare providers schedule and coordinate treatment involving i-131.

What information must be reported on i-131 treatment scheduling form?

The i-131 treatment scheduling form must include patient's personal information, treatment details, and scheduling preferences.