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4701C Oleander Drive, Myrtle Beach, SC 29577 Phone: (843) 6920040 Fax: (843) 6920046 www.ClermontRadiology.com Patient Name: ___ Patient Phone:___DOB:___ Diagnosis:___ Report onlyCDPortalOpen MRI Cervical Thoracic Lumbar Creatinine
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01
Obtain the necessary patient information such as name, date of birth, and medical record number.
02
Identify the specific imaging study that is being requested.
03
Complete the required form with the patient information and imaging study details.
04
Ensure all relevant clinical information is included to assist the radiologist in interpreting the images.
05
Submit the completed form to the radiology department for processing.

Who needs image requestclermont radiology?

01
Patients who require diagnostic imaging studies such as X-rays, CT scans, or MRIs.
02
Medical professionals such as doctors or specialists who are requesting imaging studies for their patients.
03
Insurance companies or legal entities who may need imaging studies for reimbursement or legal purposes.
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Image requestclermont radiology is a form used to request radiology imaging services at Clermont Radiology.
Any healthcare provider or medical professional who needs to request radiology imaging services at Clermont Radiology is required to file the image request form.
To fill out the image request form, you need to provide patient information, type of imaging required, reason for the imaging, and any other relevant details.
The purpose of image requestclermont radiology is to facilitate the request and scheduling of radiology imaging services for patients.
The image request form must include patient demographics, referring provider information, type of imaging needed, clinical indication, and any relevant medical history.
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