Get the free PETCT Referral Form - bsuh.nhs.uk
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PET CT Referral Form
Issued: December 2014Patient DetailsReferrer DetailsHospital/NHS Numerate of birthTitleTitleHospitalName (print)
SurnameForename(s)Specialty
OncologyOther(specify)Address
Extension
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How to fill out petct referral form
How to fill out petct referral form
01
To fill out a petct referral form, follow these steps:
02
Start by entering the patient's personal information, such as name, date of birth, and contact details.
03
Provide the patient's medical history, including any relevant past diagnoses or treatments.
04
Specify the reason for the PET-CT scan request, such as suspicion of cancer, pre-surgical planning, or response evaluation.
05
Indicate the requested radiopharmaceuticals and contrast agents to be used during the scan.
06
Include any additional instructions or requirements, such as fasting or medication restrictions before the procedure.
07
Provide the referring physician's details, including name, contact information, and professional affiliation.
08
Ensure all required fields are properly completed and double-check the form for accuracy before submission.
Who needs petct referral form?
01
The petct referral form is typically required for patients who need a positron emission tomography-computed tomography (PET-CT) scan.
02
These patients may include individuals suspected of having cancer, those requiring pre-surgical planning, or those undergoing treatment evaluation.
03
The form is usually completed by the referring physician or healthcare provider who wishes to request the PET-CT scan for their patient.
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What is petct referral form?
The PET/CT referral form is a document that is used to request a PET/CT scan for a patient.
Who is required to file petct referral form?
Medical professionals such as doctors, oncologists, or radiologists are required to file the PET/CT referral form.
How to fill out petct referral form?
The PET/CT referral form can be filled out by providing the patient's information, reason for the scan, and any relevant medical history.
What is the purpose of petct referral form?
The purpose of the PET/CT referral form is to request a PET/CT scan for a patient in order to assist in the diagnosis and treatment of certain medical conditions.
What information must be reported on petct referral form?
The PET/CT referral form must include the patient's name, date of birth, reason for the scan, relevant medical history, and any other pertinent information.
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