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RADIOLOGY SCHEDULING FORM Fax# 818.902.5139 or Scheduling Questions Contact Tel#:818.902.5200 Date of Procedure:___Requested Time:___ Length:___Last Name: ___ First Name ___ Date of Birth:___ Primary

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How to fill out radiology scheduling form

01

Step 1: Obtain a radiology scheduling form from the radiology department or download it from their website.

02

Step 2: Fill in your personal information, such as your name, address, phone number, and date of birth.

03

Step 3: Provide your insurance information, including your insurance company, policy number, and group number.

04

Step 4: Indicate the type of radiology exam you are scheduling, such as MRI, X-ray, or CT scan.

05

Step 5: Specify the reason for the exam and any specific areas that need to be focused on.

06

Step 6: Choose a preferred date and time for the appointment, based on the availability provided by the radiology department.

07

Step 7: If applicable, provide any additional instructions or special requests.

08

Step 8: Sign and date the form to certify that the information provided is accurate.

09

Step 9: Submit the completed form to the radiology department through fax, email, or in person.

Who needs radiology scheduling form?

01

Anyone who requires a radiology exam, such as an MRI, X-ray, or CT scan, needs to fill out a radiology scheduling form. This includes patients who have been referred by a doctor, as well as individuals who wish to undergo these types of imaging procedures for preventive or diagnostic purposes.

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What is radiology scheduling form?

The radiology scheduling form is a form used to schedule radiology procedures such as X-rays, MRIs, and CT scans.

Who is required to file radiology scheduling form?

Patients who need to undergo radiology procedures are required to file the scheduling form.

How to fill out radiology scheduling form?

The form can be filled out by providing personal information, insurance details, and selecting the preferred date and time for the procedure.

What is the purpose of radiology scheduling form?

The purpose of the form is to organize and schedule radiology procedures efficiently.

What information must be reported on radiology scheduling form?

Personal information, insurance details, and the preferred date and time for the procedure must be reported on the form.

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