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Last Name (Legal)Mammography RequestPreferred Name Last Penn ALL fields must be completed in order to process request n For Mammography exams, fax to Diagnostic Imaging; fax numbers listed at http://www.albertahealthservices.ca/diagnosticimaging
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How to fill out mammography request form mammography
01
To fill out a mammography request form, follow these steps:
02
Start by entering the patient's personal information, such as name, date of birth, and contact details.
03
Specify the reason for the mammography request, whether it is a routine screening or a follow-up examination.
04
Provide any relevant medical history, such as previous breast conditions, surgeries, or family history of breast cancer.
05
Indicate any symptoms or concerns the patient may have that warrant the need for mammography.
06
Include the name and contact information of the healthcare provider ordering the mammography.
07
If applicable, add any additional instructions or special requests for the radiology department.
08
Review the completed form for accuracy and make sure all required fields are filled.
09
Submit the form to the appropriate department or healthcare facility as instructed.
Who needs mammography request form mammography?
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A mammography request form is needed by individuals who require a mammogram. This typically includes women over the age of 40 or those with certain risk factors for breast cancer, as determined by their healthcare provider. Additionally, individuals who have noticed breast abnormalities or have been referred for a mammogram by their doctor will also need to fill out a mammography request form.
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