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INTERVENTIONAL RADIOLOGY REQUISITION Last NameFirst NameAddressCityHome Homework Phone Generate of BirthMiddle Initial ProvincePostal Code-N# Weight/ICBC#Known Allergies Priority:DAYMONTHFYEARMKgRoutine Emergent STATSAFETY Is
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01
To fill out the Interventional Radiology Request Form-2015, follow these steps:
02
Start by providing the patient's name, date of birth, and medical record number.
03
Specify the ordering physician's name and contact information.
04
Indicate the reason for the request and provide relevant clinical information.
05
Select the type of procedure or intervention being requested.
06
If applicable, provide any previous imaging studies or reports related to the patient's condition.
07
Include any specific instructions or precautions for the radiologist.
08
Sign and date the form to authenticate the request.
09
Make a copy of the completed form for your records.
10
Submit the form to the appropriate department or healthcare provider as instructed.

Who needs interventional-radiology-request-form-2015?

01
The Interventional Radiology Request Form-2015 is needed by healthcare providers who wish to request interventional radiology procedures or interventions for their patients.
02
This form ensures that the necessary information and authorization are provided to the radiology department to perform the requested procedure.
03
Physicians, surgeons, or other healthcare professionals who specialize in interventional radiology may use this form to communicate their requests to the radiology department.
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The interventional-radiology-request-form is a document used to request specific interventional radiology procedures and to communicate necessary patient information to ensure proper evaluation and treatment.
Healthcare providers, including physicians and specialists who are referring patients for interventional radiology procedures, are required to file the interventional-radiology-request-form.
To fill out the interventional-radiology-request-form, you need to provide patient details, the specific procedure requested, relevant medical history, and any necessary clinical information required for the procedure.
The purpose of the interventional-radiology-request-form is to facilitate proper communication between referring providers and radiology departments, ensuring that all necessary information is accounted for in order to provide safe and effective care.
The form must report patient demographics, referring physician information, the specific procedure requested, medical background, any allergies, and additional relevant diagnostic information.
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