Get the free D-H Pelvic Ultrasound Request Form - March 2019 - med dartmouth-hitchcock

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PELVIC ULTRASOUND REQUESTDepartment of RadiologyPlease complete and fax to (603)6401944 For telephone assistance: (603)6507451PATIENT INFORMATION Patient Name: DOB: / / Special Considerations:MAN:

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How to fill out d-h pelvic ultrasound request

01

To fill out a D-H pelvic ultrasound request form, follow these steps: 1. Obtain the ultrasound request form from the healthcare provider or imaging center. 2. Fill in your personal information, including your full name, date of birth, and contact details.

02

Provide your medical history, including any relevant symptoms or previous diagnoses.

03

Specify the reason for the pelvic ultrasound, such as screening for gynecological conditions, assessing pelvic pain, monitoring pregnancy, or evaluating the reproductive system.

04

Indicate any specific instructions or requirements, if applicable. For example, if you need a full bladder for the ultrasound, the form should mention this.

05

If you have any allergies or medical conditions that might affect the procedure, make sure to mention them on the form.

06

If you are taking any medications, list them on the form as well.

07

Sign and date the form to confirm that the information provided is accurate.

08

Submit the completed form to the healthcare provider or imaging center as instructed.

Who needs d-h pelvic ultrasound request?

01

A D-H pelvic ultrasound request is needed by individuals who require a pelvic ultrasound for medical reasons. This can include women who are experiencing pelvic pain, abnormal bleeding, or other gynecological symptoms that need to be evaluated. It can also be necessary for monitoring pregnancies, assessing the reproductive organs, or screening for potential abnormalities or conditions. The request form ensures that the healthcare provider has all the necessary information to perform the pelvic ultrasound accurately and provide appropriate care.

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What is d-h pelvic ultrasound request?

The d-h pelvic ultrasound request is a medical order for a diagnostic test that uses sound waves to create images of the pelvic area.

Who is required to file d-h pelvic ultrasound request?

Healthcare providers such as doctors or specialists are required to file d-h pelvic ultrasound requests for their patients.

How to fill out d-h pelvic ultrasound request?

The d-h pelvic ultrasound request should be filled out by the healthcare provider with the patient's information and relevant medical history.

What is the purpose of d-h pelvic ultrasound request?

The purpose of the d-h pelvic ultrasound request is to help diagnose and monitor conditions affecting the pelvic region.

What information must be reported on d-h pelvic ultrasound request?

The d-h pelvic ultrasound request should include the patient's name, date of birth, relevant medical history, and reason for the test.

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