Get the free IMAGING OUTPATIENT ORDER FORM - Hawaii Pacific Health

Appointment Scheduled:Scheduling: 5357000Date: Time: AM/PMB: Location: FAX: (MRI) 4853148 (CT) 4854233 (Nuclear Medicine) 4883852OUTPATIENT TESTING ORDERS PATIENT INFORMATION Patients Name (Last,

How to fill out imaging outpatient order form

How to fill out imaging outpatient order form

1. Obtain a copy of the imaging outpatient order form from the healthcare facility.
2. Fill out the patient's personal information, including their full name, date of birth, address, and contact number.
3. Provide the referring physician's information, such as their name, contact details, and professional affiliation.
4. Indicate the type of imaging procedure requested.
5. Specify any additional instructions or medical history that may be relevant to the imaging procedure.
6. Sign and date the form to certify its accuracy.
7. Submit the completed form to the appropriate department or healthcare provider.

Who needs imaging outpatient order form?

1. The imaging outpatient order form is usually required for patients who have been referred by a physician for diagnostic imaging procedures. This includes individuals who need X-rays, CT scans, MRIs, ultrasounds, and other imaging tests to aid in the diagnosis or treatment of medical conditions.

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What is imaging outpatient order form?

Imaging outpatient order form is a document used to request imaging services for a patient outside of a hospital setting.

Who is required to file imaging outpatient order form?

Medical providers such as physicians, nurse practitioners, and physician assistants are required to file imaging outpatient order forms.

How to fill out imaging outpatient order form?

To fill out the form, the provider must include patient information, reason for the imaging request, type of imaging needed, and any relevant medical history or symptoms.

What is the purpose of imaging outpatient order form?

The purpose of the form is to ensure that necessary imaging services are requested and performed for patients in an outpatient setting.

What information must be reported on imaging outpatient order form?

Patient demographics, reason for imaging request, type of imaging needed, referring provider information, and any relevant medical history must be reported on the form.