Get the free DHAI-Women's Imaging Referral Form

Women's Imaging Referral Tax ID# 341996544 / Government Tax ID# 680220314www.dignityhealth.org/advancedimagingPLEASE BRING THIS REFERRAL FORM TO YOUR SCHEDULED APPOINTMENTCENTRAL SCHEDULING WOODLAND

How to fill out dhai-womens imaging referral form

How to fill out dhai-womens imaging referral form

1. To fill out the Dhai-Women's Imaging Referral Form, follow these steps:
2. Begin by filling out the patient's personal information section, including their name, date of birth, address, and contact details.
3. Indicate the referring physician's information, including their name, address, and contact details.
4. Provide the reason for the referral in the designated section. State the symptoms or medical history that necessitate the imaging study.
5. Specify the type of imaging study requested, such as mammogram, ultrasound, or MRI.
6. Include any relevant clinical notes or additional information that may assist the radiologist in interpreting the images.
7. Sign and date the form to validate the referral.
8. Submit the completed form to the appropriate imaging center or hospital for further processing.

Who needs dhai-womens imaging referral form?

1. The Dhai-Women's Imaging Referral Form is needed by individuals who require women's imaging studies.
2. Common scenarios where this form is used include:
3. - Women undergoing routine screenings such as mammograms
4. - Patients with suspected breast abnormalities or related symptoms
5. - Individuals referred for pelvic ultrasounds or other diagnostic imaging related to women's health
6. This form helps healthcare providers communicate the need for imaging studies specifically related to women's health and ensures proper documentation and coordination of care.

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What is dhai-womens imaging referral form?

The dhai-womens imaging referral form is a document used to refer women for imaging services related to their health.

Who is required to file dhai-womens imaging referral form?

Healthcare providers who are treating women and need to refer them for imaging services are required to file the dhai-womens imaging referral form.

How to fill out dhai-womens imaging referral form?

The dhai-womens imaging referral form can be filled out by providing the patient's information, reason for referral, and any relevant medical history.

What is the purpose of dhai-womens imaging referral form?

The purpose of the dhai-womens imaging referral form is to ensure that women receive the necessary imaging services for their healthcare needs.

What information must be reported on dhai-womens imaging referral form?

The dhai-womens imaging referral form must include the patient's name, date of birth, contact information, reason for referral, and healthcare provider's information.