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EEG Requisition Neurodiagnostics Clinic 1235 Wilson Avenue (Keel & Wilson) Portal of Care B, Level 1 Phone: 4162421000 ext. 47202 Fax: 4162421066APPOINTMENT DATE: Time: Patients Name: DOB: (d/m/yr)

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How to fill out eeg requisition - humber

01

Obtain an EEG requisition form from the appropriate healthcare provider.

02

Fill out your personal information, including your full name, date of birth, and contact information.

03

Provide relevant medical history and any specific symptoms or concerns that prompted the need for an EEG.

04

Indicate the ordering healthcare provider's name, contact information, and referral details.

05

Specify the reason for the EEG and any additional notes or instructions.

06

Sign and date the requisition form.

07

Ensure all information provided is accurate and legible.

08

Submit the requisition form to the designated healthcare facility for further processing.

Who needs eeg requisition - humber?

01

Anyone who requires an electroencephalogram (EEG) test at Humber hospital or healthcare center will need an EEG requisition. This includes individuals who are experiencing symptoms that may indicate a neurological disorder or those who need to monitor brain activity for diagnostic purposes. The requisition is typically requested by a healthcare provider, such as a neurologist, who requires the EEG test to assess the patient's brain function.

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