Get the free image-guided outpatient procedure referral form - Cedars-Sinai

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GENERAL REFERRAL Form Schedule: (310) 4238000 To Fax Orders: (310) 4230137 Patient preps on reverse. Exam information: www.cedarssinai.edu/ImagingPreps * Required Fields* Patient Name: MAN:PLEASE

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How to fill out image-guided outpatient procedure referral

01

Obtain the necessary referral form from your healthcare provider or hospital.

02

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

03

Provide the details of the procedure you are requesting, including the specific body part or area that needs to be addressed.

04

Specify if there are any special instructions or considerations that the healthcare provider should be aware of.

05

If you have any relevant medical history or previous imaging results, include them with the referral.

06

Make sure to sign and date the referral form before submitting it to your healthcare provider or hospital.

Who needs image-guided outpatient procedure referral?

01

Anyone who requires an image-guided outpatient procedure should have a referral. This includes individuals who have been diagnosed with a condition or injury that can be treated or diagnosed using image-guided techniques. It is typically required by healthcare providers or hospitals to ensure appropriate and safe patient care.

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What is image-guided outpatient procedure referral?

Image-guided outpatient procedure referral is a formal request for a patient to receive imaging studies and subsequent outpatient procedures that are guided by those images, often used to assist in diagnosing or treating specific medical conditions.

Who is required to file image-guided outpatient procedure referral?

Typically, healthcare providers such as physicians or specialists who are recommending imaging studies and related outpatient procedures are required to file the image-guided outpatient procedure referral.

How to fill out image-guided outpatient procedure referral?

To fill out an image-guided outpatient procedure referral, the healthcare provider should include patient information, the specific procedure being referred, the reason for the referral, and any relevant medical history or imaging requirements.

What is the purpose of image-guided outpatient procedure referral?

The purpose of the image-guided outpatient procedure referral is to ensure that patients receive the appropriate imaging studies that can facilitate accurate diagnosis and effective treatment while also streamlining the referral process between healthcare providers.

What information must be reported on image-guided outpatient procedure referral?

The information that must be reported includes the patient's demographic information, clinical history, the type of imaging study requested, the specific outpatient procedure, and the referring physician's details.

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