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PET / CT Scan Referral Form Cobalt Imaging Center Thirlestaine Road Cheltenham Gloucestershire. GL53 7AS Tel: 01242 535923 Fax: 01242 535924RIS Number:Referral Date:Failure to complete ALL relevant
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How to fill out pet ct referral form

01
To fill out a PET CT referral form, follow these steps:
02
Start by providing your personal information, including your full name, date of birth, and contact details.
03
Next, fill in your referring physician's information, such as their name, contact details, and practice information.
04
Specify the reason for the PET CT scan referral. This may include symptoms, suspected conditions, or monitoring response to treatment.
05
Indicate the urgency of the referral if applicable.
06
Provide relevant medical history, including previous diagnoses, surgeries, medications, and allergies.
07
If necessary, include any additional information or specific instructions for the PET CT procedure.
08
Sign and date the referral form to validate it.
09
Ensure all required sections are completed accurately and legibly.
10
Submit the completed referral form to the designated healthcare provider or facility.

Who needs pet ct referral form?

01
A PET CT referral form is typically needed by individuals who require a PET CT scan as part of their medical evaluation or treatment.
02
This may include patients with suspected or diagnosed cancer, those undergoing cancer treatment, or individuals with certain neurological or cardiac conditions.
03
Referring physicians use the PET CT referral form to ensure proper documentation and communication between healthcare providers involved in a patient's care.
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A PET CT referral form is a document that healthcare providers use to request a PET CT scan for a patient, providing necessary clinical information to facilitate the procedure.
Typically, healthcare providers such as physicians, oncologists, or specialists who suspect certain medical conditions requiring imaging are required to file the PET CT referral form.
To fill out a PET CT referral form, the healthcare provider should include patient information, clinical history, indications for the scan, and any specific requirements for the imaging procedure.
The purpose of the PET CT referral form is to ensure that all relevant patient information is communicated to the imaging facility, improving the accuracy of diagnosis and treatment planning.
The information that must be reported includes patient demographics, medical history, symptoms, the reason for the scan, and any previous imaging studies related to the current condition.
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