Get the free affiliatedpet.comAPSPETCTOrderForm2018PET/CT SCAN REFERRAL FORM - Affiliated PET

PET/CT Referral Form 1400 Forest Glen Rd. Ste 430, Silver Spring, MD 20910 Scheduling: 301.681.9100 | Fax: 301.681.9141 | Tax ID: 522294497PATIENT INFORMATION ___[1] Patient Name_________ [2] Date

How to fill out affiliatedpetcomapspetctorderform2018petct scan referral form

How to fill out affiliatedpetcomapspetctorderform2018petct scan referral form

1. To fill out the affiliatedpetcomapspetctorderform2018petct scan referral form, follow these steps:
2. Start by entering the required patient information, such as name, date of birth, and contact details.
3. Provide relevant medical history and any specific instructions or concerns related to the patient's condition.
4. Indicate the type of PET/CT scan required and the reason for the referral.
5. Include any additional tests or imaging studies that have already been performed.
6. Make sure to fill out the referring physician's details, including name, contact information, and medical license number.
7. Finally, review the form for any errors or missing information before submitting it.
8. Note: It is important to consult the specific instructions or guidelines provided by Affiliated PET/CT services if available.

Who needs affiliatedpetcomapspetctorderform2018petct scan referral form?

1. The affiliatedpetcomapspetctorderform2018petct scan referral form is typically needed by:
2. - Physicians or healthcare professionals who are referring patients for PET/CT scans.
3. - Patients who have been advised by their healthcare provider to undergo a PET/CT scan and need to provide the referral form to the imaging center.
4. - Imaging centers or radiology departments that require a completed referral form before scheduling and conducting a PET/CT scan.

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What is affiliatedpetcomapspetctorderform2018petct scan referral form?

The affiliatedpetcomapspetctorderform2018petct scan referral form is a document used to authorize and request a PET CT scan for patients in healthcare settings.

Who is required to file affiliatedpetcomapspetctorderform2018petct scan referral form?

Healthcare providers, such as doctors or specialists, are required to file the affiliatedpetcomapspetctorderform2018petct scan referral form when ordering a PET CT scan for patients.

How to fill out affiliatedpetcomapspetctorderform2018petct scan referral form?

To fill out the form, providers need to include patient information, the reason for the referral, details of the examination, and any relevant medical history.

What is the purpose of affiliatedpetcomapspetctorderform2018petct scan referral form?

The purpose of the form is to document the medical necessity for a PET CT scan and to ensure proper authorization for the procedure.

What information must be reported on affiliatedpetcomapspetctorderform2018petct scan referral form?

The form must report patient demographics, referring physician information, clinical indications, and any specific notes or instructions related to the scan.