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Mallinckrodt Institute of Radiology Barnes Jewish Hospital Physician Request Form for Brain PET Imaging Patient Name Social Security No. Address City, State, Zip Patient's Phone Date of Study Previous
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How to fill out physician pet brain request11-14-06doc
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Start by opening the physician pet brain request11-14-06doc document.
02
Familiarize yourself with the sections and information required to fill out the form.
03
Begin by providing the patient's personal information such as their name, date of birth, and contact details.
04
Move on to the medical history section and accurately fill in the relevant details regarding the patient's past and present medical conditions.
05
Ensure to provide specific details of why a PET brain scan is being requested for the patient.
06
If applicable, include any relevant information about the patient's allergies, previous surgeries, or medications they are currently taking.
07
Make sure to accurately fill out the physician's information including their name, contact details, and signature.
08
Review the completed form for any errors or missing information.
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Once you are satisfied with the filled-out form, save a copy for your records and submit it according to the specified procedure or to the appropriate authority.
Who needs physician pet brain request11-14-06doc?
01
The physician pet brain request11-14-06doc is needed by medical professionals or physicians who require a PET brain scan for their patients.
02
It is typically used to request a specialized brain imaging procedure to diagnose or monitor various neurological conditions such as tumors, dementia, or other brain disorders.
03
This document helps facilitate communication between the physician and the medical facility responsible for conducting the PET brain scan.
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What is physician pet brain request11-14-06doc?
Physician pet brain request11-14-06doc is a medical document requesting a PET scan of the brain for diagnostic purposes.
Who is required to file physician pet brain request11-14-06doc?
Physicians or healthcare providers responsible for ordering the PET scan and interpreting the results are required to file physician pet brain request11-14-06doc.
How to fill out physician pet brain request11-14-06doc?
Physician pet brain request11-14-06doc should be completed with patient information, reason for the PET scan, any relevant medical history, and physician's signature.
What is the purpose of physician pet brain request11-14-06doc?
The purpose of physician pet brain request11-14-06doc is to document the medical need for a PET scan of the brain and ensure proper authorization.
What information must be reported on physician pet brain request11-14-06doc?
Physician pet brain request11-14-06doc must include patient demographics, clinical indication for the PET scan, relevant medical history, and physician's contact information.
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