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WhidbeyHealth Medical Center 101 N. Main Street, Cookeville WA, 98239 360.678.5151 360.321.5151 www.whidbeyhealth.orgDIAGNOSTIC IMAGING REQUISITION Scheduling Line: 3606787607 MF 8am5pm, Sat 8am4pm)
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How to fill out diagnostic imaging requisition

01
Begin by obtaining the diagnostic imaging requisition form from your healthcare provider or hospital.
02
Fill out your personal information accurately and completely. This may include your name, date of birth, address, and contact information.
03
Provide relevant medical information, such as your medical history, previous diagnostic results, and any specific symptoms or concerns you have.
04
Indicate the type of diagnostic imaging test you require by checking the appropriate box or providing the necessary details.
05
Specify additional instructions, if any, such as the urgency of the test or the specific area of the body that needs to be examined.
06
Confirm the details provided and review the requisition form for any errors or missing information.
07
Sign and date the form to certify its accuracy and completeness.
08
Submit the completed diagnostic imaging requisition form to the designated healthcare facility or department as instructed.

Who needs diagnostic imaging requisition?

01
A diagnostic imaging requisition is needed by individuals who require medical imaging tests to aid in the diagnosis and treatment of their medical condition.
02
This may include patients who have experienced trauma or injury, individuals with suspected or confirmed illnesses or diseases, and those who are undergoing routine screening or monitoring.
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Diagnostic imaging requisition is a form or request that is used to order medical imaging tests such as X-rays, MRIs, CT scans, and ultrasounds.
Medical professionals such as doctors, physicians, or radiologists are required to file diagnostic imaging requisitions.
To fill out a diagnostic imaging requisition, the medical professional must provide patient information, the type of imaging test needed, and the reason for the test.
The purpose of diagnostic imaging requisition is to order specific medical imaging tests to help diagnose and monitor medical conditions.
The diagnostic imaging requisition must include patient demographics, the ordering physician's information, the type of test needed, and the reason for the test.
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