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Gorilla Soldiers Memorial Hospital170 Colborne St. West, Gorilla, ON L3V 2Z3 Tel: 7053279126 Fax: 7053279176Request for Nuclear Medicine Examination (By Appointment Only)PATIENT INFORMATION INPATIENT NO.OUTPATIENTAPPOINTMENT
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How to fill out request for nuclear medicine

01
To fill out a request for nuclear medicine, follow these steps:
02
Start by gathering the necessary information, including the patient's personal details, medical history, and relevant clinical findings.
03
Identify the specific type of nuclear medicine procedure required and include it in the request.
04
Provide any specific instructions or precautions for the patient to follow before the procedure.
05
Include information about any pre-existing conditions or allergies that may affect the administration of nuclear medicine.
06
Indicate the reason for the request and any relevant medical indications.
07
Include the name and contact information of the referring physician or healthcare professional.
08
Double-check the completed request form for accuracy and completeness before submitting it to the appropriate department or facility.

Who needs request for nuclear medicine?

01
A request for nuclear medicine is typically needed for patients who require diagnostic or therapeutic procedures using radioactive substances.
02
Specific individuals who may need a request for nuclear medicine include:
03
- Patients with suspected or diagnosed cancer, as nuclear medicine can be used to detect and monitor tumor activity.
04
- Individuals with certain cardiac conditions, as nuclear medicine imaging can provide valuable information about heart function and blood flow.
05
- Patients with thyroid disorders, as nuclear medicine techniques such as thyroid scans can help assess thyroid function and identify any abnormalities.
06
- Individuals with certain bone conditions, as nuclear medicine bone scans can detect fractures, infections, and bone tumors.
07
It is important to note that the decision to request nuclear medicine ultimately lies with the healthcare professional based on the individual's specific medical needs and condition.
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Request for nuclear medicine is a formal document filled out by healthcare professionals to request the use of nuclear medicine imaging or treatment for a patient.
Any healthcare professional, such as a doctor or radiologist, who wants to use nuclear medicine for a patient is required to file a request for nuclear medicine.
The request for nuclear medicine should be filled out with the patient's information, reason for the request, specific test or treatment needed, and any relevant medical history.
The purpose of the request for nuclear medicine is to ensure that the use of nuclear medicine is appropriate and safe for the patient, based on their medical condition and symptoms.
The request for nuclear medicine must include the patient's name, date of birth, medical history, reason for the request, specific test or treatment needed, and any relevant lab results.
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