Canada STEGH Diagnostic Imaging Requisition Form 2017-2025 free printable template
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PLEASE PRINT CLEARLYDiagnostic Imaging Requisition Ray/CT/Mammography/OBS/BMD Phone: 5196312020 Ext. 2000 Fax: 5196318842 SE# Last Name Health Card# VC First Name D.O.B.YYY/MM/Patient Phone: PLEASE
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How to fill out diagnostic imaging requisition form
How to fill out Canada STEGH Diagnostic Imaging Requisition Form
01
Obtain a copy of the Canada STEGH Diagnostic Imaging Requisition Form.
02
Fill in the patient's personal information, including full name, address, and date of birth.
03
Indicate the referring physician's details, such as name, contact information, and clinic address.
04
Specify the type of imaging required (e.g., X-ray, MRI, CT scan) in the designated section.
05
Provide clinical information or reason for the requisition to help guide the imaging process.
06
Include relevant health history or current medications that may impact the imaging results.
07
Sign and date the requisition form if required by your clinic or hospital policy.
08
Submit the completed form to the imaging department, either in person, by fax, or electronically as specified.
Who needs Canada STEGH Diagnostic Imaging Requisition Form?
01
Healthcare providers who are ordering diagnostic imaging for their patients.
02
Patients who are being referred for diagnostic imaging by their healthcare provider.
03
Clinics and hospitals that require documentation for imaging services.
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What is Canada STEGH Diagnostic Imaging Requisition Form?
The Canada STEGH Diagnostic Imaging Requisition Form is a standardized document used by healthcare providers to request diagnostic imaging services for patients. It helps ensure that the necessary information is communicated to the imaging facility for proper patient care.
Who is required to file Canada STEGH Diagnostic Imaging Requisition Form?
Healthcare professionals, such as doctors or specialists, who seek diagnostic imaging services for their patients are required to fill out and submit the Canada STEGH Diagnostic Imaging Requisition Form.
How to fill out Canada STEGH Diagnostic Imaging Requisition Form?
To fill out the form, healthcare providers must provide patient information, specify the type of imaging required, detail relevant medical history, and any specific instructions necessary for the imaging procedure.
What is the purpose of Canada STEGH Diagnostic Imaging Requisition Form?
The purpose of the form is to facilitate clear and efficient communication between healthcare providers and diagnostic imaging facilities, ensuring that patients receive the appropriate imaging exams based on their medical needs.
What information must be reported on Canada STEGH Diagnostic Imaging Requisition Form?
The required information includes patient demographics (such as name, date of birth, and health card number), the referring physician's details, the requested imaging type (e.g., MRI, CT scan), relevant clinical history, and any other pertinent details that may affect the imaging procedure.
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