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RDM×Outpatient×Imaging×Request×Foraminal×Emergency×and×Specialty×Care739×Warren×Ave. Portland, ×ME041032078783121Email:imaging×Jermaine.follow×these×steps:1. Complete form2. Fax×to 20787808293.

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How to fill out ultrasound imaging request form2017

01

Here is how to fill out the ultrasound imaging request form for 2017:

02

- Start by entering the patient's personal information, such as name, date of birth, and contact details.

03

- Specify the referring physician's details, including their name, contact information, and any relevant identification numbers.

04

- Indicate the reason for the ultrasound imaging request by providing a brief description or the specific medical condition being investigated.

05

- Enter the type of ultrasound examination requested, such as abdominal, pelvic, cardiac, or musculoskeletal.

06

- If applicable, provide any additional instructions or specific areas of interest for the radiologist to focus on during the examination.

07

- Ensure all required fields are filled out accurately and completely.

08

- Finally, review the form for any errors or missing information before submitting it to the appropriate healthcare facility.

Who needs ultrasound imaging request form2017?

01

The ultrasound imaging request form for 2017 is needed by healthcare professionals, including referring physicians, to request ultrasound examinations for their patients.

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What is ultrasound imaging request form2017?

Ultrasound imaging request form2017 is a form used to request ultrasound imaging services.

Who is required to file ultrasound imaging request form2017?

Medical practitioners or healthcare providers may be required to file ultrasound imaging request form2017.

How to fill out ultrasound imaging request form2017?

Ultrasound imaging request form2017 can be filled out by providing patient information, reason for the request, and any relevant medical history.

What is the purpose of ultrasound imaging request form2017?

The purpose of ultrasound imaging request form2017 is to facilitate the request and scheduling of ultrasound imaging procedures for patients.

What information must be reported on ultrasound imaging request form2017?

Patient demographics, referring physician information, reason for the request, and relevant medical history must be reported on ultrasound imaging request form2017.

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