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Radiology Imaging Center
Request for Import of Outside CD Images
* Please note that hard copy cross-sectional studies will not be imported into PACS. Digital CDs of
any exam and hard copy plain films
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How to fill out radiology imaging services request

How to fill out radiology imaging services request
01
To fill out a radiology imaging services request, follow these steps:
02
Obtain the appropriate request form from the radiology department or download it from their website.
03
Fill in your personal information, including your full name, date of birth, and contact details.
04
Provide your insurance information, such as the name of your insurance provider and your policy number.
05
Indicate the type of radiology imaging service you require. This could include X-rays, CT scans, MRIs, ultrasounds, or other specialized imaging techniques.
06
Specify the reason for the request and any relevant symptoms or medical history that may assist the radiologist in interpreting the results.
07
If necessary, provide any additional instructions or requests for the radiology department, such as scheduling preferences or any specific concerns.
08
Review the completed request form to ensure all information is accurate and legible.
09
Submit the form to the radiology department either in person, by mail, or through any online submission process they may offer.
10
If required, make sure to bring any necessary pre-authorization or referral documentation from your healthcare provider.
Who needs radiology imaging services request?
01
A radiology imaging services request is needed by individuals who require diagnostic imaging tests or procedures to aid in the diagnosis or monitoring of a medical condition.
02
This can include patients who have been referred by their healthcare provider to undergo imaging studies for various reasons.
03
Radiology imaging services are commonly requested for evaluating injuries, diagnosing diseases or abnormalities, planning treatments, or monitoring the progress of a condition.
04
Examples of individuals who may require radiology imaging services include patients with suspected fractures, cancer patients undergoing treatment, individuals with cardiovascular conditions, pregnant women for prenatal ultrasounds, or athletes with sports-related injuries.
05
Ultimately, anyone who needs a radiology imaging study as part of their healthcare management may require a radiology imaging services request.
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What is radiology imaging services request?
Radiology imaging services request is a form used to request imaging services such as X-rays, MRIs, CT scans, etc.
Who is required to file radiology imaging services request?
Healthcare providers or facilities requesting imaging services are required to file radiology imaging services request.
How to fill out radiology imaging services request?
Radiology imaging services request should be filled out with the patient's information, type of imaging needed, and any relevant medical history.
What is the purpose of radiology imaging services request?
The purpose of radiology imaging services request is to facilitate the scheduling and performance of imaging procedures for diagnostic or treatment purposes.
What information must be reported on radiology imaging services request?
Information such as patient demographics, referring provider information, type of imaging requested, and any specific clinical indications must be reported on radiology imaging services request.
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