Get the free Screening Mammography Scheduling Request Form - mercydesmoines

Screening Mammography Scheduling Request Form Send Form Thank-you for choosing Mercy for your Mammogram. We offer Digital Mammography at each of our three convenient locations (Ankeny, Clive, and

How to fill out screening mammography scheduling request

How to fill out a screening mammography scheduling request:

Start by gathering all the necessary information:

1. Personal details such as name, date of birth, and contact information.
2. Insurance information, including the policy number and any required authorizations.
3. Referral information from your healthcare provider, if applicable.

Contact the mammography facility:

1. Call or visit the website of the mammography facility where you would like to schedule your screening.
2. Inquire about their specific process for scheduling a screening mammography appointment.
3. Make sure to ask about any required paperwork or forms that need to be filled out.

Complete the screening mammography scheduling request form:

1. Obtain the form from the mammography facility, either in person or from their website.
2. Fill in your personal and insurance information accurately and legibly.
3. Check if the facility provides any specific instructions or guidelines for completing the form and follow them accordingly.
4. Make sure to double-check all the entered details for accuracy before submitting the request.

Attach any necessary documents:

1. If the mammography facility requires any additional documents, such as an authorization form or a referral letter, ensure that you include them with your scheduling request.
2. If unsure about any specific requirements, contact the facility and ask for clarification.

Submit the scheduling request:

1. Return the completed form and any attached documents to the mammography facility using the method specified by them (such as mail, email, fax, or in person).
2. If submitting via mail or email, make sure to address it to the appropriate department or contact person mentioned by the facility.
3. Keep a copy of the completed form and any other documents for your records.

Who needs a screening mammography scheduling request?

A screening mammography scheduling request is typically needed by individuals who:

1. Are due for their regular screening mammogram as recommended by their healthcare provider or based on their age and risk factors.
2. Have been referred for a mammogram by their healthcare provider due to specific symptoms or concerns.
3. Have had a previous abnormal result on a mammogram and require follow-up or further testing.

It is essential to consult with your healthcare provider or the mammography facility directly to determine if you need a screening mammography scheduling request and to understand the specific requirements of the facility.

For pdfFiller’s FAQs

What is screening mammography scheduling request?

Screening mammography scheduling request is a request made to schedule a mammogram for breast cancer screening.

Who is required to file screening mammography scheduling request?

Patients who are due for regular breast cancer screenings are required to file screening mammography scheduling request.

How to fill out screening mammography scheduling request?

To fill out a screening mammography scheduling request, patients need to provide their personal information, medical history, and availability for appointments.

What is the purpose of screening mammography scheduling request?

The purpose of screening mammography scheduling request is to ensure that individuals receive regular mammograms for early detection of breast cancer.

What information must be reported on screening mammography scheduling request?

Information such as patient's name, date of birth, contact information, insurance details, medical history, and any previous mammogram results must be reported on the screening mammography scheduling request.

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