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Request for Nuclear MedicinePatient InformationHumber River Hospital 1235 Wilson Ave. LEVEL 1 Toronto, ON M3M 0B2 Phone 4162421000 Ext. 63823 Fax 4162421117Name ___Appointment InformationAddress ___SHIP

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How to fill out request for nuclear medicine

01

Obtain the necessary referral form from the ordering physician.

02

Fill out the patient's demographic information, including name, date of birth, and contact information.

03

Provide relevant medical history and reason for the nuclear medicine study, if known.

04

Specify the type of nuclear medicine procedure needed, along with any specific radiopharmaceuticals or contrasts required.

05

Include any relevant laboratory or imaging results that may aid in the interpretation of the study.

06

Sign and date the request form before submitting it to the nuclear medicine department.

Who needs request for nuclear medicine?

01

Patients who have been referred by their physician for further diagnostic or therapeutic nuclear medicine studies.

02

Physicians or healthcare providers who are ordering nuclear medicine procedures for their patients.

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What is request for nuclear medicine?

Request for nuclear medicine is a formal document or authorization needed to proceed with the use of nuclear medicine procedures for diagnostic or therapeutic purposes.

Who is required to file request for nuclear medicine?

Typically, the requesting physician or healthcare provider is responsible for filing the request for nuclear medicine.

How to fill out request for nuclear medicine?

The request for nuclear medicine usually requires specific patient information, reason for the procedure, type of nuclear medicine test needed, and any relevant medical history.

What is the purpose of request for nuclear medicine?

The purpose of the request for nuclear medicine is to ensure that the appropriate procedures are followed and that the patient receives the necessary diagnostic or therapeutic treatment.

What information must be reported on request for nuclear medicine?

The request for nuclear medicine must include patient demographics, referring physician information, reason for the procedure, type of test needed, and any relevant medical history or allergies.

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