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BONE DENSITY STUDY (DA) REQUESTDepartment of RadiologyPlease complete and fax to: (603)6401944 For telephone assistance: (603)6539388PATIENT INFORMATION Patient Name: Medicare: Primary Secondary Patient
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Start by gathering all the necessary information about the patient and their medical history.
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Begin by filling out the patient's personal information, including their name, date of birth, and contact information.
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Provide any relevant insurance information, such as policy numbers or group numbers.
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Specify the reason for the radiology pet, whether it is for diagnosis, treatment planning, or monitoring.
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Indicate the type of procedure or test that is being requested, such as an X-ray, MRI, or CT scan.
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Include any specific instructions or requests for the radiology department, such as the need for sedation or contrast agents.
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Sign and date the form to acknowledge that all the provided information is accurate and complete.
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Submit the completed form to the department of radiology, either in person or through the designated submission process.
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The department of radiology PET refers to the division responsible for conducting positron emission tomography scans.
Radiologists, technologists, or other healthcare professionals involved in the use or interpretation of PET scans are required to file department of radiology PET.
To fill out the department of radiology PET, one must provide accurate information about the patient, the procedure, and the findings of the PET scan.
The purpose of the department of radiology PET is to document and track the use of PET scans for diagnostic or treatment purposes.
The department of radiology PET must include details such as patient demographics, scan date, scan findings, and interpreting physician.
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