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CT REQUISITION PLEASE FAX COMPLETED REQ TO 6133458324 As of July 2021Last Name: ___ First Name: ___ Date of Birth: ___ Address: ___ City: ___ Postal Code: ___ Phone Number: ___Health Card #: ___ VC:
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How to fill out ct scan requisition
How to fill out ct scan requisition
01
Start by entering the patient's personal information such as name, date of birth, and contact information.
02
Indicate the reason for the CT scan by providing relevant medical history and symptoms.
03
Specify the type of CT scan required and any special instructions for the procedure.
04
Include the referring physician's information and signature for authorization.
05
Double-check all information for accuracy before submitting the requisition.
Who needs ct scan requisition?
01
Patients who have been recommended by their healthcare provider to undergo a CT scan.
02
Healthcare professionals who are referring a patient for further diagnostic imaging.
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What is ct scan requisition?
A ct scan requisition is a form filled out by a healthcare provider to request a computed tomography scan for a patient.
Who is required to file ct scan requisition?
CT scan requisition must be filed by healthcare providers such as doctors, physician assistants, or nurse practitioners.
How to fill out ct scan requisition?
To fill out a ct scan requisition, the healthcare provider must provide patient information, reason for the scan, and any special instructions.
What is the purpose of ct scan requisition?
The purpose of a ct scan requisition is to authorize and request a computed tomography scan for diagnostic purposes.
What information must be reported on ct scan requisition?
The ct scan requisition must include patient demographics, clinical history, reason for the scan, and any relevant medical history.
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