Get the free Mammography Requisition - Cobourg

Mammography/OBS/Breast U/Please fax all NHS Mammography/OBS/Breast U/S Requisitions to (905) 37369141000 De Palma Drive, Cyborg, ON K9A 5W6 Tel 9053777795 Fax 9053736914Ordering Physician/Practitioner

How to fill out mammography requisition - cobourg

How to fill out mammography requisition - cobourg

1. Obtain the mammography requisition form from your healthcare provider or the imaging clinic in Cobourg.
2. Fill out your personal information accurately, including your full name, date of birth, address, and contact information.
3. Provide details about your medical history, any symptoms you are experiencing, and your family history of breast cancer or other relevant conditions.
4. Indicate the reason for the mammogram, such as routine screening, diagnostic evaluation, or follow-up after a previous abnormal test result.
5. If you have insurance coverage for the mammogram, include your policy information and any required authorization codes.
6. Sign and date the requisition form before submitting it to the imaging clinic for scheduling.

Who needs mammography requisition - cobourg?

1. Individuals in Cobourg who are recommended by their healthcare provider for a mammogram.
2. Women over a certain age or with a family history of breast cancer who are proactive about their breast health.
3. Patients who have symptoms or findings that warrant further investigation through a mammography procedure.

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What is mammography requisition - cobourg?

Mammography requisition in Cobourg is a form or document used to request a mammogram for breast cancer screening.

Who is required to file mammography requisition - cobourg?

Patients, healthcare providers, or clinics are required to file mammography requisition in Cobourg.

How to fill out mammography requisition - cobourg?

To fill out mammography requisition in Cobourg, include the patient's information, healthcare provider's details, reason for the screening, and any relevant medical history.

What is the purpose of mammography requisition - cobourg?

The purpose of mammography requisition in Cobourg is to schedule and perform a mammogram for breast cancer detection and screening.

What information must be reported on mammography requisition - cobourg?

Mammography requisition in Cobourg must include patient demographics, healthcare provider information, reason for screening, and relevant medical history.