Get the free PET/CT Patient Request Form Please ... - Alliance Medical UK

AM PET CT Pat Req Rest Apr15 aw:NHS FAQ Mar 08 20/04/2015 12:17 Page 1PET/CT Patient Request Form PATIENT DETAILS HOSPITAL NO:NHS NO:Title:Surname:First name:Please refer to page 2 for the contraindications

How to fill out petct patient request form

How to fill out petct patient request form

1. Start by writing the patient's name and contact information at the top of the form.
2. Fill in the relevant medical history of the patient, including any pre-existing conditions or medications they are taking.
3. Indicate the reason for the PET/CT scan, whether it is for cancer diagnosis, staging, or follow-up.
4. Specify any prior imaging studies that have been done and include the date of those studies.
5. Provide information about any recent surgeries or procedures the patient has undergone.
6. Fill in the physician's details, including their name, contact information, and signature.
7. Finally, review the form for accuracy and completeness before submitting it for processing.

Who needs petct patient request form?

1. The PET/CT patient request form is needed by patients who require a PET/CT scan for diagnostic or monitoring purposes. This includes individuals suspected of having cancer, those who have already been diagnosed with cancer and need staging or follow-up scans, and patients who may require PET/CT for other medical conditions such as cardiac or neurological disorders.

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What is petct patient request form?

The petct patient request form is a document used to request a PET-CT scan for a patient.

Who is required to file petct patient request form?

The healthcare provider or physician responsible for the patient's care is required to file the petct patient request form.

How to fill out petct patient request form?

The petct patient request form must be filled out with the patient's personal information, medical history, and reason for needing a PET-CT scan.

What is the purpose of petct patient request form?

The purpose of the petct patient request form is to authorize a PET-CT scan for a specific patient based on medical necessity.

What information must be reported on petct patient request form?

The petct patient request form must include the patient's name, date of birth, medical history, reason for the scan, and relevant clinical information.