Lenox Hill Radiology Electronic Referral Form free printable template

Reset Submit Precept./Ref. # s: Apt. Date/Time: Date issued: Tel: (212) 772-3111 Fax: (212) 734-5832 www.lenoxhillradiology.com 61 East 77th Street, New York, NY 10075 130 West 79th Street, New York,

How to fill out hill radiology referral pdf form

How to fill out Lenox Hill Radiology Electronic Referral Form

1. Visit the Lenox Hill Radiology website or obtain a physical copy of the Electronic Referral Form.
2. Fill in the patient's personal information, including full name, date of birth, and contact details.
3. Provide the referring physician's information, including name, contact number, and medical practice.
4. Select the type of radiology services needed from the provided options.
5. Fill in any relevant medical history or notes that may assist the radiology team.
6. Review the information for accuracy and completeness.
7. Submit the form electronically through the website or hand a physical copy to the appropriate office.

Who needs Lenox Hill Radiology Electronic Referral Form?

1. Patients who require radiological examinations or procedures.
2. Referring physicians who need to direct their patients for diagnostic imaging services.
3. Healthcare professionals coordinating patient care that involves radiology services.

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What is Lenox Hill Radiology Electronic Referral Form?

The Lenox Hill Radiology Electronic Referral Form is a digital document used by healthcare providers to refer patients for radiology services at Lenox Hill Hospital.

Who is required to file Lenox Hill Radiology Electronic Referral Form?

Healthcare providers, including doctors and specialists who need to refer patients for radiology services, are required to file the Lenox Hill Radiology Electronic Referral Form.

How to fill out Lenox Hill Radiology Electronic Referral Form?

To fill out the Lenox Hill Radiology Electronic Referral Form, providers should provide the patient's demographics, medical history, reason for the referral, and any specific imaging requests before submitting it electronically.

What is the purpose of Lenox Hill Radiology Electronic Referral Form?

The purpose of the Lenox Hill Radiology Electronic Referral Form is to streamline the referral process, improve communication between healthcare providers, and ensure that patients receive timely radiology services.

What information must be reported on Lenox Hill Radiology Electronic Referral Form?

The information that must be reported includes the patient's name, date of birth, insurance details, referring physician's information, reason for the referral, and specific radiology exams requested.