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850 Portland Street Dartmouth, NS B2W 2N3 T: 902.435.2444 F: 902.462.5285 referrals@petworksvet.ca petfocus.ca/petworks/Ultrasound Referral Form REFERRING VETERINARY INFORMATION Dr. ___ Hospital Name:
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How to fill out ultrasound referral form
How to fill out ultrasound referral form
01
Obtain the ultrasound referral form from the referring physician or medical office.
02
Fill out the patient's personal information including name, date of birth, and contact details.
03
Provide relevant medical history or reason for the ultrasound referral.
04
Indicate the type of ultrasound needed and any specific instructions.
05
Sign and date the referral form before submitting it to the imaging center or healthcare provider.
Who needs ultrasound referral form?
01
Patients who have been recommended by their healthcare provider to undergo an ultrasound examination.
02
Healthcare providers who are referring patients for ultrasound imaging to aid in diagnosis or treatment.
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What is ultrasound referral form?
Ultrasound referral form is a document used to request an ultrasound examination for a patient.
Who is required to file ultrasound referral form?
Healthcare providers such as doctors or specialists are required to file ultrasound referral forms for their patients.
How to fill out ultrasound referral form?
Ultrasound referral forms can be filled out by providing patient information, reason for the ultrasound request, and any relevant medical history.
What is the purpose of ultrasound referral form?
The purpose of ultrasound referral form is to request an ultrasound examination to help diagnose medical conditions.
What information must be reported on ultrasound referral form?
Patient information, reason for the ultrasound request, referring healthcare provider details, and any relevant medical history must be reported on the ultrasound referral form.
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