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INTERVENTIONAL RADIOLOGY REFERRAL FORM FAX form to 5136367794 STAT request call 5136368547 3333 Burned Ave. Cincinnati, Ohio 452293039In addition to faxing this order, please call 5136368547 PATIENT
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How to fill out interventional radiology referral form
How to fill out interventional radiology referral form
01
Step 1: Start by entering the patient's personal information, such as their name, date of birth, and contact details.
02
Step 2: Specify the reason for the referral and provide a brief summary of the patient's medical history related to the need for interventional radiology.
03
Step 3: Indicate the desired procedure or intervention requested by selecting it from the options provided.
04
Step 4: Include any relevant imaging or test results that might assist in the evaluation and decision-making process.
05
Step 5: Don't forget to sign and date the referral form before submitting it.
Who needs interventional radiology referral form?
01
The interventional radiology referral form is typically required by healthcare professionals such as primary care physicians, specialists, or other medical practitioners who intend to refer a patient to an interventional radiologist for a specific procedure or intervention.
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What is interventional radiology referral form?
The interventional radiology referral form is a document used by healthcare providers to request specialized imaging and procedures performed by interventional radiologists.
Who is required to file interventional radiology referral form?
Healthcare providers, such as physicians and specialists, are required to file the interventional radiology referral form for their patients who need interventional radiology services.
How to fill out interventional radiology referral form?
To fill out the interventional radiology referral form, a healthcare provider needs to provide patient information, clinical history, the specific procedure being requested, and any relevant imaging studies.
What is the purpose of interventional radiology referral form?
The purpose of the interventional radiology referral form is to facilitate coordination between healthcare providers and radiologists, ensuring appropriate and timely care for patients requiring interventional procedures.
What information must be reported on interventional radiology referral form?
The information that must be reported includes patient demographics, reason for the referral, relevant medical history, and specific details about the requested intervention or imaging study.
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