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233913 breast imaging request.exp_Layout 1 11/12/2018 09:20 Page 1BREAST IMAGING REQUEST PATIENT INFORMATION *TLC unit no.×indicates mandatory fields(if known)(dd/mm/YYY)n Embassy Selfsame SponsorMember
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What is breast imaging request form?
Breast imaging request form is a document used to request imaging exams, such as mammograms, ultrasounds, or MRIs, for the evaluation of breast health.
Who is required to file breast imaging request form?
Medical providers, such as physicians or nurse practitioners, are required to fill out the breast imaging request form.
How to fill out breast imaging request form?
The form should be completed with patient information, clinical history, reason for imaging, and any relevant findings.
What is the purpose of breast imaging request form?
The purpose of the form is to provide necessary information for the radiology department to perform the requested imaging exams.
What information must be reported on breast imaging request form?
Patient's name, date of birth, reason for imaging, clinical history, referring physician's information, and any relevant findings or concerns.
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