Get the free PET/CT Order Form - oregonimaging.com

Due to patient privacy laws, we are unable to accept emailed forms. Please fax or print to ensure patient information is not subject to unauthorized access.PET/CT Order Form PET/CT Scheduler: (541)

How to fill out petct order form

How to fill out petct order form

1. Start by entering the name of the patient and their date of birth in the appropriate fields.
2. Provide the contact information of the referring physician, including their name, phone number, and address.
3. Indicate the diagnosis or reason for ordering the PET/CT scan.
4. Specify any relevant medical history or previous imaging studies that may assist in the interpretation of the scan.
5. If applicable, include the name and dosage of any medications the patient is currently taking.
6. Choose the type of PET/CT scan required and any additional imaging protocols or procedures.
7. Note any specific instructions or precautions that need to be followed before the scan.
8. Finally, sign and date the order form to certify its validity.

Who needs petct order form?

1. The PET/CT order form is typically needed by healthcare professionals such as referring physicians, oncologists, radiologists, or other specialists who require a PET/CT scan to aid in the diagnosis, staging, or monitoring of a patient's condition.

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What is petct order form?

The PETCT order form is a document used to request a PET/CT scan, which combines Positron Emission Tomography (PET) and Computed Tomography (CT) imaging for diagnostic purposes.

Who is required to file petct order form?

Typically, healthcare providers such as physicians and specialists who are requesting a PET/CT scan for their patients are required to file the PETCT order form.

How to fill out petct order form?

To fill out the PETCT order form, provide patient information, the reason for the scan, clinical history, any relevant previous imaging, and the physician's details, while ensuring all required fields are completed accurately.

What is the purpose of petct order form?

The purpose of the PETCT order form is to formally request a PET/CT scan, ensuring that the imaging facility has all necessary information to perform the procedure and bill for it appropriately.

What information must be reported on petct order form?

Information that must be reported on the PETCT order form includes patient identification details, clinical indication for the scan, relevant medical history, and referring physician contact information.