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ORTHOPEDIC Imaging Evaluation Form The following information is necessary to comply with the federally mandated ICD10 billing requirements, which takes effective Oct. 1st 2015.NAME: ___Age: ___Weight:

How to fill out orthopedic imaging evaluation form

How to fill out orthopedic imaging evaluation form

1. Begin by filling out the patient's personal information such as name, date of birth, and contact information.
2. Record the reason for the imaging evaluation, indicating the specific area of concern or injury.
3. Provide a detailed patient history, including any relevant medical conditions, previous injuries, and current symptoms.
4. Specify any medications the patient is currently taking, as well as any known allergies.
5. Document the results of any physical examinations or tests that have already been performed.
6. Select the appropriate imaging modalities to be used (X-ray, MRI, CT scan, etc.) based on the patient's condition.
7. Ensure that all sections of the form are completed accurately and legibly before submitting it for review.

Who needs orthopedic imaging evaluation form?

1. Orthopedic surgeons
2. Physical therapists
3. Sports medicine physicians
4. Orthopedic specialists
5. Primary care physicians referring patients for imaging evaluations

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What is orthopedic imaging evaluation form?

Orthopedic imaging evaluation form is a document used to record and assess the results of imaging tests such as X-rays, MRI, or CT scans related to orthopedic conditions.

Who is required to file orthopedic imaging evaluation form?

Orthopedic imaging evaluation form is typically filed by orthopedic surgeons, radiologists, or other healthcare professionals who request and interpret imaging studies for patients with orthopedic issues.

How to fill out orthopedic imaging evaluation form?

To fill out an orthopedic imaging evaluation form, one must provide patient information, type of imaging study performed, findings or results of the study, interpretation of the results, and recommendations for treatment.

What is the purpose of orthopedic imaging evaluation form?

The purpose of orthopedic imaging evaluation form is to document and communicate the results of imaging tests conducted for orthopedic evaluation, which helps in diagnosing and treating musculoskeletal conditions.

What information must be reported on orthopedic imaging evaluation form?

The orthopedic imaging evaluation form must include patient demographics, details of imaging study performed, impressions or interpretations of findings, recommendations for further evaluation or treatment.