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Tel 408-297-8844 Fax 408-297-8220 Tax ID# 77-0554982 2211 Moor park Ave., Suite 220, San Jose CA 95128 C O m p u t e r i z e d To m o g r a p h y (C T) R e f e r an l For m Patient Name: Tel: Date:

How to fill out computerized tomography ct referral

How to fill out a computerized tomography (CT) referral:

1. Start by providing the patient's basic information, including their full name, date of birth, and contact information.
2. Indicate the reason for the CT referral. Include any relevant medical history or symptoms that led to the decision to perform a CT scan.
3. Specify the type of CT scan required. Different types of CT scans focus on different areas of the body, so it is important to accurately describe the intended purpose of the scan.
4. Include any specific instructions or requirements for the CT scan. This could include the need for contrast dye, fasting before the scan, or any other necessary preparations.
5. If applicable, mention any allergies or previous adverse reactions to contrast dye or other substances used in CT scans.
6. Include the referring healthcare provider's information, including their name, contact details, and credentials.
7. Finally, make sure to sign and date the referral form before submitting it to the appropriate department or imaging center for further processing.

Who needs a computerized tomography (CT) referral:

1. Individuals who require further investigation or evaluation of a particular medical condition or symptom may need a CT referral.
2. Patients who have undergone initial diagnostic tests that suggest the need for a more detailed and precise imaging procedure like a CT scan may require a referral.
3. Healthcare providers who need assistance or confirmation of a diagnosis or treatment plan may refer patients for a CT scan.
4. Patients who are experiencing unexplained pain, abnormal growths, suspected fractures, or other conditions that can be visualized using CT imaging may benefit from a referral.
5. Patients who are undergoing treatment for certain diseases, such as cancer, may require regular CT scans to monitor their condition and treatment progress. In such cases, referrals may be needed for each subsequent scan.

For pdfFiller’s FAQs

What is computerized tomography ct referral?

Computerized tomography (CT) referral is a document or request made by a healthcare provider to schedule a CT scan for a patient.

Who is required to file computerized tomography ct referral?

Healthcare providers, such as doctors or specialists, are typically required to file a computerized tomography (CT) referral for their patients.

How to fill out computerized tomography ct referral?

To fill out a computerized tomography (CT) referral, the healthcare provider needs to include the patient's personal information, reason for the CT scan, any relevant medical history, and provider's contact information.

What is the purpose of computerized tomography ct referral?

The purpose of a computerized tomography (CT) referral is to request a CT scan for a patient in order to diagnose or monitor a medical condition.

What information must be reported on computerized tomography ct referral?

The computerized tomography (CT) referral must include the patient's name, date of birth, reason for the scan, referring provider's information, and any relevant medical history or previous imaging results.

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