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REQUEST FOR MAMMOGRAPHY SERVICES Breast Center of Excellence Ordering care provider Patients name DOB *Best daytime phone number to contact patient Alternate Date last clinical breast exam was performed
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What is request for mammography services?
Request for mammography services is a formal process of requesting a mammogram, a screening test for breast cancer.
Who is required to file request for mammography services?
The request for mammography services is typically filed by a healthcare provider or a physician on behalf of the patient.
How to fill out request for mammography services?
The request for mammography services can be filled out by providing the necessary patient information, reason for the mammogram, and any relevant medical history.
What is the purpose of request for mammography services?
The purpose of the request for mammography services is to schedule a mammogram for a patient for early detection of breast cancer.
What information must be reported on request for mammography services?
The request for mammography services must include patient demographics, reason for the mammogram, referring physician information, and any relevant medical history.
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