Get the free breast imaging requisition - Cambridge Health Alliance

Department of Radiology Breast Imaging Service Scheduling 6176651298BREAST IMAGING REQUISITION Name: DOB: MAN: Date and Time of Appointment: Location:Cambridge Hospital Campus 1493 Cambridge St. Cambridge,

How to fill out breast imaging requisition

How to fill out breast imaging requisition

1. To fill out a breast imaging requisition, follow these steps:
2. Start by writing the patient's personal information such as name, date of birth, and address.
3. Provide the patient's medical history and any relevant information related to previous breast imaging examinations.
4. Indicate the reason for the breast imaging request, whether it is for routine screening, diagnostic evaluation, or follow-up.
5. Specify the type of breast imaging test required, such as mammography, ultrasound, or MRI.
6. Include any additional instructions or special considerations for the imaging procedure, if necessary.
7. If the requisition is being filled out by a healthcare provider, ensure their name, contact information, and signature are provided.
8. Double-check all the information filled out on the requisition for accuracy and completeness before submitting it.

Who needs breast imaging requisition?

1. Breast imaging requisition is typically needed by individuals who require breast imaging examinations for various reasons. These reasons may include:
2. - Women undergoing routine breast cancer screening
3. - Individuals with suspicious breast symptoms or abnormalities
4. - Patients with a known history of breast cancer or high risk factors
5. - Individuals participating in breast cancer research studies or clinical trials
6. - Women seeking a second opinion regarding a breast condition
7. It is important to consult with a healthcare provider to determine if a breast imaging requisition is necessary in specific cases.

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What is breast imaging requisition?

A breast imaging requisition is a formal document that healthcare providers use to request breast imaging services, such as mammograms or ultrasound, for patients.

Who is required to file breast imaging requisition?

Healthcare providers, such as doctors or radiologists, are required to file breast imaging requisitions on behalf of their patients.

How to fill out breast imaging requisition?

To fill out a breast imaging requisition, a healthcare provider must enter patient information, specify the type of imaging needed, provide clinical indications, and sign the requisition.

What is the purpose of breast imaging requisition?

The purpose of a breast imaging requisition is to ensure that patients receive appropriate imaging services based on their medical history and current symptoms, facilitating early detection of breast issues.

What information must be reported on breast imaging requisition?

Information that must be reported includes patient demographics (name, date of birth, contact information), clinical history, specific imaging requested, and referring physician details.