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Diagnostic Imaging Request Form (Except MRI and CT) Please complete ALL sections Incomplete forms will be returned If the request is urgent please fax to: 020 8401 3454 Otherwise please post to: Radiology

How to fill out chs diagnostic imaging request

How to fill out CHS diagnostic imaging request:

1. Start by accessing the CHS diagnostic imaging request form.
2. Fill in your personal information, including your name, date of birth, and contact information. This is important for identification purposes and for receiving any follow-up communication.
3. Provide information about the ordering physician, including their name, contact information, and any relevant medical credentials.
4. Indicate the type of diagnostic imaging requested. This may include options such as X-ray, MRI, CT scan, ultrasound, or other specific imaging modalities.
5. Specify the reason for the imaging request. This could be a specific medical condition, symptoms, or any other relevant information that the physician needs to be aware of.
6. If you have any existing medical conditions or allergies, make sure to note them on the form. This information is crucial for the imaging technicians to ensure your safety during the procedure.
7. Some imaging requests may require additional details or instructions. For example, if you are pregnant or have a pacemaker, this information needs to be communicated to the imaging facility.
8. Double-check all the information you have provided on the form to ensure accuracy. Incorrect or incomplete information can lead to delays or errors in the imaging process.
9. Once you have completed the form, submit it to the appropriate contact at the imaging facility. This may involve handing it to the front desk, mailing it, or submitting it electronically, depending on the specific instructions provided.

Who needs CHS diagnostic imaging request:

1. Patients who require further diagnostic assessment for a specific medical condition or symptom.
2. Physicians or healthcare professionals who need to order diagnostic imaging for their patients to aid in diagnosis or treatment planning.
3. Insurance companies or healthcare organizations that require documentation for reimbursement or approval purposes.

For pdfFiller’s FAQs

What is chs diagnostic imaging request?

The chs diagnostic imaging request is a form used to request diagnostic imaging services for patients.

Who is required to file chs diagnostic imaging request?

Medical professionals such as doctors, nurses, or technicians are required to file the chs diagnostic imaging request.

How to fill out chs diagnostic imaging request?

To fill out the chs diagnostic imaging request, the medical professional must provide patient information, type of imaging needed, and reason for the imaging request.

What is the purpose of chs diagnostic imaging request?

The purpose of the chs diagnostic imaging request is to facilitate the scheduling and performance of diagnostic imaging procedures for patients.

What information must be reported on chs diagnostic imaging request?

The chs diagnostic imaging request must include patient demographics, medical history, referring physician information, type of imaging needed, and reason for the imaging request.

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