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RADIOLOGY SCHEDULING: Fax: 901.322.2994 Phone: 901.609.3556WEST CANCER CENTER & RESEARCH INSTITUTE: RADIOLOGY PHYSICIAN ORDER FORM PATIENT INFORMATION: (all fields are required)___ LAST NAME___ PHONE
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How to fill out radiology order form
How to fill out radiology order form
01
Obtain the necessary patient information such as name, date of birth, and medical record number.
02
Ensure the referring physician's information is accurate and complete.
03
Specify the type of radiology procedure being requested.
04
Provide any relevant clinical information or symptoms that may assist the radiologist in interpreting the results.
05
Obtain any necessary pre-authorization or insurance information.
06
Review the form for accuracy and completeness before submitting it to the radiology department.
Who needs radiology order form?
01
Patients who are referred for imaging procedures by their healthcare providers.
02
Healthcare providers such as physicians, nurse practitioners, or physician assistants who order imaging tests for their patients.
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What is radiology order form?
The radiology order form is a document used by healthcare providers to request radiology imaging procedures for patients.
Who is required to file radiology order form?
Healthcare providers such as doctors, physician assistants, and nurse practitioners are required to file the radiology order form.
How to fill out radiology order form?
The radiology order form is typically filled out by providing patient information, the requested imaging procedure, and the reason for the request.
What is the purpose of radiology order form?
The purpose of the radiology order form is to ensure that the correct imaging procedures are performed on patients based on the healthcare provider's recommendation.
What information must be reported on radiology order form?
Information such as patient name, date of birth, reason for imaging request, type of imaging procedure requested, and healthcare provider's information must be reported on the radiology order form.
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