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Physician Order Form for Imaging Services Diagnostic Imaging Services 3181 SW Sam Jackson Park Road, Portland OR 97239 Radiology Scheduling: 5034180990 Fax: 5034944621 Patient Information Patient

How to fill out physician order form imaging

How to fill out physician order form imaging

1. To fill out a physician order form for imaging, follow these steps:
2. Start by writing the date on the top of the form.
3. Enter the patient's full name and date of birth.
4. Provide the patient's contact information, including phone number and address.
5. Mention the referring physician's name and contact details.
6. Specify the type of imaging test required, such as MRI, CT scan, or X-ray.
7. Indicate the reason for the imaging test, including any relevant symptoms or medical conditions.
8. Include any special instructions or specific areas to be examined.
9. List any known allergies or pre-existing medical conditions that may affect the imaging procedure.
10. If applicable, include any previous imaging results or relevant medical history.
11. Sign the form and provide your professional credentials as the ordering physician.
12. Make sure to provide a copy of the completed form to the patient and the imaging facility.
13. Keep a copy of the form in the patient's medical records for future reference.

Who needs physician order form imaging?

1. Physician order forms for imaging are typically required for patients who need to undergo imaging tests such as MRI, CT scan, ultrasound, or X-ray.
2. These forms are usually filled out by the referring physician or healthcare provider who wants to order the imaging procedure.
3. The form ensures that the request for imaging is properly documented and helps the imaging facility understand the specific requirements for the patient.

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What is physician order form imaging?

Physician order form imaging is a form that is filled out by a medical physician to request specific imaging tests for a patient.

Who is required to file physician order form imaging?

Medical physicians are required to file physician order form imaging when requesting imaging tests for their patients.

How to fill out physician order form imaging?

Physicians must fill out the form with patient information, specific imaging tests requested, reason for the tests, and other relevant details.

What is the purpose of physician order form imaging?

The purpose of physician order form imaging is to accurately request and document the need for specific imaging tests for patients.

What information must be reported on physician order form imaging?

The form must include patient demographics, specific imaging tests requested, reason for the tests, physician's information, and date of request.