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Health Record #: Complete or place barcoded patient label here Patient Name: (Print first, last) mm dd by DOB: / / 596 Davis Drive Newmarket, ON L3Y 2P9Phone #: CT Requisition OUTPATIENT q INPATIENT

How to fill out 667300533 form

How to fill out ct requisition - southlake

1. To fill out a CT requisition at Southlake, follow these steps:
2. Obtain the CT requisition form from the hospital or clinic.
3. Fill in your personal information, including your full name, address, date of birth, and contact details.
4. Provide your healthcare insurance information, if applicable.
5. Specify the reason for the CT scan and any specific details requested by your healthcare provider.
6. Ensure that all sections of the form are completed accurately and legibly.
7. Review the form to make sure there are no errors or missing information.
8. Sign and date the requisition form.
9. Submit the filled-out CT requisition form to the appropriate department at Southlake for further processing.
10. Wait for further instructions from the hospital regarding your CT scan appointment.
11. Note: It's always advisable to consult with your healthcare provider or the staff at Southlake for any specific instructions or additional requirements.

Who needs ct requisition - southlake?

1. Anyone who requires a CT scan at Southlake may need a CT requisition. This includes patients who have been recommended a CT scan by their healthcare provider to investigate or diagnose a medical condition.
2. The CT requisition helps ensure that the appropriate scan is performed and that the necessary information is provided to the radiology department at Southlake for accurate interpretation of the results.
3. It is important to consult with your healthcare provider to determine if a CT scan is necessary and if you require a requisition for the scan.

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What is ct requisition - southlake?

CT requisition - Southlake is a formal request for a computed tomography (CT) scan to be performed at Southlake Regional Health Centre.

Who is required to file ct requisition - southlake?

CT requisition - Southlake can be filed by healthcare providers, physicians, or specialists who have determined that a CT scan is necessary for diagnosis or treatment.

How to fill out ct requisition - southlake?

CT requisition - Southlake can be filled out by providing patient information, reason for the CT scan, relevant history, and any specific instructions or requests.

What is the purpose of ct requisition - southlake?

The purpose of CT requisition - Southlake is to request a CT scan in order to obtain detailed images of the inside of the body for medical evaluation.

What information must be reported on ct requisition - southlake?

CT requisition - Southlake must include patient demographics, clinical history, reason for the scan, referring physician information, and any specific scan instructions.