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PET/CT Outpatient Service Request×PROF×PCOFImaging 3168046170 or 8008113183 ext. 2300, Fax 3168046266Fax # 3168046266Please use black, ballpoint pen only. Press down firmly. Thank outcall REPORT
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How to fill out petct outpatient service request

01
Begin by ensuring that you have all the necessary information about the patient, such as their name, date of birth, and contact details.
02
Next, obtain the requisition form for the PET/CT outpatient service request from your healthcare provider or hospital.
03
Fill out the patient's personal information accurately on the form, including their full name, address, and contact number.
04
Provide the patient's date of birth and gender in the designated fields.
05
Indicate the reason for the PET/CT outpatient service request clearly and concisely.
06
Specify any relevant medical history or previous diagnostic tests that may be pertinent to the request.
07
Enter the name and contact information of the referring physician or healthcare provider.
08
If applicable, include any additional instructions or special requirements for the PET/CT procedure.
09
Double-check all the information filled in the form to ensure its accuracy and completeness.
10
Submit the filled-out PET/CT outpatient service request form to the appropriate department or healthcare facility.

Who needs petct outpatient service request?

01
The PET/CT outpatient service request is required for individuals who need to undergo a PET/CT scan as part of their medical diagnosis or treatment.
02
Patients who have been referred by their healthcare provider or physician for further evaluation or monitoring may require this service request.
03
Individuals who have specific medical conditions or symptoms that necessitate a PET/CT scan may also need to fill out this request form.
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The PETCT outpatient service request is a form used to request a positron emission tomography and computed tomography (PET-CT) scan for outpatient services.
The attending physician or healthcare provider is required to file the PETCT outpatient service request.
The PETCT outpatient service request can be filled out by providing patient information, clinical history, reason for the scan, and any relevant medical details.
The purpose of the PETCT outpatient service request is to authorize and schedule a PET-CT scan for outpatient diagnostic imaging.
The PETCT outpatient service request must include patient demographics, clinical indication, referring physician details, and any relevant medical history.
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