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Laxly Dental 3D Imaging Central Us :+353(0)1 6246655
4 The Mall, Main Street,
Laxly, Co Kildare. W23 P2P4.
info@tooth.ie www.tooth.ieDental ImagingImaging Referral Document
Referred by:Patient Details:Name:
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How to fill out referral form for cbct
How to fill out referral form for cbct
01
Obtain the referral form for CBCT from the referring dentist or healthcare provider.
02
Fill out the patient's personal information, including name, date of birth, and contact information.
03
Provide details on the reason for the referral and what specific areas need to be imaged using CBCT.
04
Include any relevant medical history or current medications that may impact the CBCT scan.
05
Sign and date the referral form before sending it to the imaging center or specialist.
Who needs referral form for cbct?
01
Dentists or healthcare providers who suspect a patient may benefit from a CBCT scan to assist in diagnosis and treatment planning.
02
Patients who have been referred by their dentist or healthcare provider for a CBCT scan to further evaluate a specific dental or medical condition.
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What is referral form for cbct?
Referral form for CBCT is a document used to request a cone beam computed tomography (CBCT) scan for a patient.
Who is required to file referral form for cbct?
Dentists and oral healthcare providers are required to file referral forms for CBCT scans.
How to fill out referral form for cbct?
Referral forms for CBCT scans are typically filled out by providing patient information, reason for scan, and specific instructions for the radiology department.
What is the purpose of referral form for cbct?
The purpose of referral form for CBCT is to request a detailed 3D image of the patient's teeth, jaw, and surrounding structures for diagnostic or treatment planning purposes.
What information must be reported on referral form for cbct?
The referral form for CBCT must include patient's name, date of birth, reason for scan, referring provider's information, and any relevant medical history.
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