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Department of Nuclear Medicine Pretoria Academic Hospital Request Form for PET/CT Imaging **Please note that no appointment date will be given without a COMPLETED Request form** A: Patient Detail

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How to fill out request form for pet-ct

01

Obtain the request form for the pet-ct scan from the healthcare provider or facility.

02

Fill out your personal information, such as name, date of birth, and contact information.

03

Provide information about the reason for the scan and any relevant medical history.

04

Make sure to follow any specific instructions provided on the form, such as fasting requirements.

05

Review the form for accuracy and completeness before submitting it to the healthcare provider or facility.

Who needs request form for pet-ct?

01

Patients who have been recommended to undergo a pet-ct scan by their healthcare provider.

02

Medical professionals who are referring a patient for a pet-ct scan.

03

Healthcare facilities and imaging centers that perform pet-ct scans.

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What is request form for pet-ct?

The request form for pet-ct is a document used to request a positron emission tomography-computed tomography scan.

Who is required to file request form for pet-ct?

Medical professionals such as doctors and healthcare providers are required to file the request form for pet-ct on behalf of their patients.

How to fill out request form for pet-ct?

The request form for pet-ct should be completed by providing patient information, relevant medical history, reason for the scan, and any other required details.

What is the purpose of request form for pet-ct?

The purpose of the request form for pet-ct is to facilitate the scheduling and documentation of a positron emission tomography-computed tomography scan for a patient.

What information must be reported on request form for pet-ct?

The request form for pet-ct must include patient demographics, medical history, reason for the scan, relevant laboratory results, and any other pertinent information.

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