Tufts University Cone-Beam Computed Tomography (CBCT) Referral Form free printable template
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For Office Use Only Date of Appointment: Time: MAXILLOFACIAL DIAGNOSTIC IMAGING SERVICES One Knee land Street, Boston MA 02111 Cone-Beam Computed Tomography (CBC) Referral Referring Dentist Information
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How to fill out cbct referral form
How to fill out Tufts University Cone-Beam Computed Tomography (CBCT) Referral
01
Obtain the Tufts University CBCT Referral form from the appropriate source.
02
Fill in the patient's personal information, including name, date of birth, and contact details.
03
Provide the referring physician's details, including name, practice name, and contact information.
04
Indicate the reason for the referral clearly in the specified section.
05
Include any relevant medical history or previous imaging results that may assist in the interpretation of the CBCT.
06
Specify any specific areas of interest or concerns that should be addressed during the scan.
07
Sign and date the referral form to validate it.
08
Submit the completed form to the appropriate department at Tufts University for processing.
Who needs Tufts University Cone-Beam Computed Tomography (CBCT) Referral?
01
Patients requiring detailed imaging of dental and facial structures for accurate diagnosis.
02
Dentists and oral surgeons who need advanced imaging to plan treatment for complex cases.
03
Orthodontists needing precise information for treatment planning.
04
Any specialist who requires enhanced visualization of anatomy that traditional X-rays may not provide.
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What is Tufts University Cone-Beam Computed Tomography (CBCT) Referral?
Tufts University Cone-Beam Computed Tomography (CBCT) Referral is a formal request for imaging services provided by Tufts University that utilizes cone-beam CT technology. This imaging technique offers high-resolution 3D images of dental and facial structures for diagnostic purposes.
Who is required to file Tufts University Cone-Beam Computed Tomography (CBCT) Referral?
Referrals must be filed by licensed dental professionals such as dentists, orthodontists, or oral surgeons who determine the necessity of CBCT imaging for their patients.
How to fill out Tufts University Cone-Beam Computed Tomography (CBCT) Referral?
To fill out the Tufts CBCT Referral, the referring provider must complete a form that includes patient information, clinical indications for the scan, any necessary medical history, and the specific areas to be imaged.
What is the purpose of Tufts University Cone-Beam Computed Tomography (CBCT) Referral?
The purpose of the Tufts CBCT Referral is to obtain detailed 3D imaging that aids in diagnosis, treatment planning, and the evaluation of complex dental and maxillofacial conditions.
What information must be reported on Tufts University Cone-Beam Computed Tomography (CBCT) Referral?
The information required on the Tufts CBCT Referral includes the patient's demographic details, referring provider information, clinical findings, indication for the CBCT, and specific imaging requests.
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