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Queen Square Imaging Center 811 Queen Square London WC1N 3AR 020 7833 2513 020 7837 8074 www.queensquare.com Computed Tomography (CT) Referral Form Please complete this form with all known details
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How to fill out ct scan referral form
How to fill out ct scan referral form
01
Obtain the CT scan referral form from the appropriate healthcare provider or facility.
02
Fill out the patient's personal information such as name, date of birth, and contact information.
03
Provide the reason for the CT scan referral, including any relevant medical history or symptoms.
04
Indicate any specific instructions or preferences for the CT scan, if applicable.
05
Ensure that the form is signed and dated by the healthcare provider issuing the referral.
Who needs ct scan referral form?
01
Patients who have been recommended to undergo a CT scan by their healthcare provider.
02
Healthcare providers who are referring a patient for a CT scan to further investigate a medical condition.
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What is ct scan referral form?
The CT scan referral form is a document used to request a computed tomography scan for a patient.
Who is required to file ct scan referral form?
Medical professionals such as doctors, radiologists, or specialists are required to file the CT scan referral form for their patients.
How to fill out ct scan referral form?
The CT scan referral form must be filled out with the patient's personal information, reason for the scan, and any relevant medical history.
What is the purpose of ct scan referral form?
The purpose of the CT scan referral form is to authorize and provide information for a CT scan procedure for a patient.
What information must be reported on ct scan referral form?
The CT scan referral form must include the patient's name, date of birth, reason for the scan, ordering physician, and any relevant medical history.
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