UCHealth Radiology Imaging Request Form free printable template

RADIOLOGY IMAGING REQUEST FORM pH: 7208489396 Metro Denver: Fax: 7208481651 North Region: Fax: 9704957671 Email: UCHRadiologyOrderingProviderSupport@uchealth.orgIN ADDITION TO THIS FORM: Documents

How to fill out uchealth imaging form

How to fill out UCHealth Radiology Imaging Request Form

1. Obtain the UCHealth Radiology Imaging Request Form from the UCHealth website or clinic.
2. Fill in patient information including name, date of birth, and contact details.
3. Specify the type of imaging requested (e.g., X-ray, MRI, CT scan).
4. Include the clinical indication for the imaging (reason for request).
5. List any relevant medical history or prior imaging results.
6. Provide the referring physician's details.
7. Check the date for the scheduled imaging appointment, if applicable.
8. Sign and date the form, confirming that all information is accurate.
9. Submit the completed form to the appropriate UCHealth imaging department.

Who needs UCHealth Radiology Imaging Request Form?

1. Patients who require diagnostic imaging as directed by their healthcare provider.
2. Referring physicians who need to request imaging services for their patients.
3. Clinics or healthcare facilities coordinating imaging referrals.

People Also Ask about

What is a diagnostic imaging report?

Diagnostic Imaging Report. Description. Interpreted results of imaging test that includes the study performed, reason, findings, and impressions. Includes both structured and unstructured (narrative) components.

What are the three main types of diagnostic imaging?

The most common types of diagnostic radiology exams include: Computed tomography (CT), also known as a computerized axial tomography (CAT) scan, including CT angiography. Fluoroscopy, including upper GI and barium enema. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)

What are radiological procedures?

The most common types of diagnostic radiology exams include: Computed tomography (CT), also known as a computerized axial tomography (CAT) scan, including CT angiography. Fluoroscopy, including upper GI and barium enema. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) Mammography.

What is an imaging report?

A detailed report that describes the results of an imaging test. A radiology report includes information about the type of imaging test that was done and how it was done. It also includes a brief medical history of the person having the test, including any symptoms or known diseases and why the test was needed.

What is the meaning of diagnostic imaging?

Diagnostic imaging lets doctors look inside your body for clues about a medical condition. A variety of machines and techniques can create pictures of the structures and activities inside your body. The type of imaging your doctor uses depends on your symptoms and the part of your body being examined.

Is diagnostic imaging the same as CT scan?

Diagnostic imaging techniques help narrow the causes of an injury or illness and ensure that the diagnosis is accurate. These techniques include X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.

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What is UCHealth Radiology Imaging Request Form?

The UCHealth Radiology Imaging Request Form is a document used by healthcare providers to request radiological imaging services for patients, including procedures such as X-rays, MRI, and CT scans.

Who is required to file UCHealth Radiology Imaging Request Form?

Healthcare providers, including physicians and authorized clinicians, are required to file the UCHealth Radiology Imaging Request Form to facilitate the scheduling and documentation of imaging services.

How to fill out UCHealth Radiology Imaging Request Form?

To fill out the UCHealth Radiology Imaging Request Form, a healthcare provider should complete all required fields accurately, including patient information, clinical indications, and the specific imaging procedure requested.

What is the purpose of UCHealth Radiology Imaging Request Form?

The purpose of the UCHealth Radiology Imaging Request Form is to ensure that imaging services are requested appropriately based on a patient's medical needs, facilitating efficient and accurate patient care.

What information must be reported on UCHealth Radiology Imaging Request Form?

The information that must be reported on the UCHealth Radiology Imaging Request Form includes patient demographics, clinical history, the specific imaging requested, and any relevant details that support the medical necessity of the imaging.