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68GaDOTATATE PET Requisition to PET Center BE COMPLETED BY THE REFERRING PHYSICIAN The following indications are part of the Ontario PET Registry. Completion of a post scan form is required following

How to fill out 68ga-dotatate pet requisition to

How to fill out 68ga-dotatate pet requisition to

1. To fill out a 68ga-dotatate pet requisition form, follow these steps:
2. Begin by providing the patient's personal information, including their full name, date of birth, and gender.
3. Next, enter the referring physician's details, such as their name, contact information, and medical license number.
4. Specify the reason for the requisition by selecting the appropriate options from the provided choices or by providing a detailed explanation if necessary.
5. Indicate the specific imaging procedure required, which in this case is a 68ga-dotatate PET scan.
6. Include any relevant medical history or previous imaging studies that may assist in the interpretation of the scan results.
7. If there are any specific imaging instructions or requirements, such as fasting or medication restrictions, make sure to note them clearly.
8. Review the completed requisition form for accuracy and completeness before submitting it to the appropriate department or facility for processing.

Who needs 68ga-dotatate pet requisition to?

1. A 68ga-dotatate PET requisition form is typically needed by referring physicians or healthcare professionals who wish to request a 68ga-dotatate PET scan for their patients.
2. This type of scan may be required for various reasons, including the evaluation, staging, or monitoring of certain neuroendocrine tumors or other conditions where the detection of somatostatin receptors is essential.
3. Patients who have been recommended or prescribed a 68ga-dotatate PET scan by their healthcare provider may also require a requisition form to initiate the imaging procedure.

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What is 68ga-dotatate pet requisition to?

68ga-dotatate pet requisition is a request for a PET scan using the radiopharmaceutical 68Ga-DOTATATE to help diagnose and monitor neuroendocrine tumors.

Who is required to file 68ga-dotatate pet requisition to?

The ordering physician or healthcare provider is required to file the 68ga-dotatate PET requisition.

How to fill out 68ga-dotatate pet requisition to?

To fill out the 68ga-dotatate PET requisition, the ordering physician must provide patient information, reason for the scan, and any relevant medical history.

What is the purpose of 68ga-dotatate pet requisition to?

The purpose of 68ga-dotatate PET requisition is to request a specialized PET scan using a specific radiopharmaceutical to help diagnose or monitor neuroendocrine tumors.

What information must be reported on 68ga-dotatate pet requisition to?

The 68ga-dotatate PET requisition must include patient demographics, clinical history, reason for scan, relevant lab results, and ordering physician information.