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CT ICONOGRAPHY (CTC) REQUISITION PLEASE FAX COMPLETED REQ TO 6133458324 As of April 2018Last Name: ___ First Name: ___ Date of Birth: ___ Address: ___ City: ___ Postal Code: ___ Phone Number: ___Health

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How to fill out ct colonography ctc requisition

01

Obtain the requisition form for CT colonography (CTC) from the healthcare provider.

02

Fill out the patient's personal information such as name, date of birth, and contact information.

03

Provide the reason for the CTC request and any relevant medical history.

04

Specify if the patient has any allergies to contrast dye or other medications.

05

Indicate if the patient has any implanted medical devices or other health conditions that may impact the procedure.

06

Sign and date the requisition form before submitting it to the imaging facility.

Who needs ct colonography ctc requisition?

01

Individuals who are at average or increased risk for colorectal cancer may need a CT colonography (CTC) requisition.

02

Patients with symptoms such as abdominal pain, rectal bleeding, or changes in bowel habits may also require a CTC requisition.

03

Healthcare providers may order a CTC requisition for screening purposes or to further evaluate abnormalities detected during a previous test.

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What is ct colonography ctc requisition?

CT colonography (CTC) requisition is a form or document used to request a computed tomography (CT) scan of the colon to screen for colorectal cancer.

Who is required to file ct colonography ctc requisition?

Medical professionals such as gastroenterologists, primary care physicians, and radiologists are typically required to file CT colonography (CTC) requisitions.

How to fill out ct colonography ctc requisition?

To fill out a CT colonography (CTC) requisition, the medical professional must provide patient information, reason for the scan, and any relevant medical history.

What is the purpose of ct colonography ctc requisition?

The purpose of a CT colonography (CTC) requisition is to screen for colorectal cancer and detect abnormalities in the colon.

What information must be reported on ct colonography ctc requisition?

The CT colonography (CTC) requisition must include patient demographics, clinical information, indications for the scan, and any relevant medical history.

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