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NHCH MRI Exam Order 2015-2025 free printable template

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FACSIMILE 671125 MAMALAHOA HIGHWAY, SAMUEL, HI 96743 p 808.885.4444 l f 808.881.4404 l www.NHCH.comTo:Imaging Department MRI SchedulerFrom:Fax:8088814841Tel:Tel:8088814842Date:# Of Pages with Cover
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How to fill out NHCH MRI Exam Order

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How to fill out NHCH MRI Exam Order

01
Begin by obtaining the NHCH MRI Exam Order form.
02
Fill in the patient's personal details, including name, date of birth, and contact information.
03
Specify the type of MRI being requested and include any relevant medical history.
04
Indicate the referring physician's details and contact information.
05
Provide the insurance information, including policy number and provider.
06
Sign and date the form to authorize the MRI exam.
07
Submit the completed form to the appropriate department at NHCH.

Who needs NHCH MRI Exam Order?

01
Patients with suspected neurological or musculoskeletal conditions.
02
Individuals experiencing unexplained pain or symptoms requiring detailed imaging.
03
Anyone referred by a physician for an MRI examination at NHCH.
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NHCH MRI Exam Order is a formal request for Magnetic Resonance Imaging (MRI) to be conducted at NHCH, detailing the specifics of the examination needed for a patient.
Healthcare professionals, such as physicians and specialists, are required to file the NHCH MRI Exam Order on behalf of their patients.
To fill out the NHCH MRI Exam Order, one must provide the patient's personal information, the clinical indication for the MRI, the type of MRI needed, and any special considerations or instructions.
The purpose of the NHCH MRI Exam Order is to ensure that the appropriate imaging studies are performed to diagnose or monitor medical conditions accurately.
The NHCH MRI Exam Order must include the patient's name, date of birth, clinical history, the specific MRI type requested, and the physician's information.
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