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IMAGING SERVICES ORDER Forename: Organization: Postal Address: Phone (day / mobile): State Library of Western Australia Perth Cultural Center PERTH WA 6000 Orders phone: 08 9427 3450 Orders fax: 08

How to fill out imaging services order form

How to fill out imaging services order form

1. Start by opening the imaging services order form document.
2. Read through the instructions and understand the necessary information required.
3. Begin by filling out the patient details section, including full name, date of birth, and contact information.
4. Move on to the ordering physician section, providing the doctor's name, contact details, and any specific instructions.
5. Next, fill in the details of the imaging study requested, such as the type of scan needed and any additional tests or images required.
6. If applicable, indicate any previous imaging studies that need comparison or provide relevant medical history information.
7. Complete the insurance information section, including the patient's insurance provider, policy number, and any necessary authorizations.
8. Review the entire form for accuracy and completeness before submitting.
9. Once satisfied, sign and date the form to certify the accuracy of the information provided.
10. Make a copy of the completed order form for your records and submit the original to the imaging services provider.

Who needs imaging services order form?

1. Imaging services order forms are needed by medical professionals, such as physicians, surgeons, and other healthcare providers.
2. Patients who require imaging studies, such as X-rays, CT scans, MRIs, or ultrasounds, also need these order forms.
3. Insurance companies and healthcare facilities may also require imaging services order forms to process claims and ensure proper documentation.

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What is imaging services order form?

The imaging services order form is a document used to request imaging services such as MRIs, CT scans, and X-rays from healthcare providers.

Who is required to file imaging services order form?

Healthcare providers who are requesting imaging services for their patients are required to file the imaging services order form.

How to fill out imaging services order form?

To fill out the imaging services order form, you need to provide patient information, details of the requested imaging service, and physician's information, ensuring all required fields are completed accurately.

What is the purpose of imaging services order form?

The purpose of the imaging services order form is to formalize and document the request for imaging services, ensuring proper communication between healthcare providers and imaging facilities.

What information must be reported on imaging services order form?

The information that must be reported includes patient demographics, insurance information, the type of imaging service requested, clinical indications, and ordering physician’s details.