OHSU Physician Order Form for Imaging Services 2023-2025 free printable template

Physician Order Form for Imaging Services Diagnostic Imaging Services 3181 SW Sam Jackson Park Road, Portland OR 97239 Radiology Scheduling: 5034180990 Fax: 5034944621 REQUIRED FIELDS: Patient Demographics

How to fill out ohsu imaging order form

How to fill out OHSU Physician Order Form for Imaging Services

1. Obtain the OHSU Physician Order Form for Imaging Services from the OHSU website or your clinical office.
2. Fill in the patient's personal information including name, date of birth, and insurance details.
3. Select the appropriate imaging service required, such as X-ray, MRI, or CT scan.
4. Indicate the clinical indication or reason for the imaging order clearly.
5. Specify any special instructions or preparation needed by the patient prior to the imaging procedure.
6. Provide the referring physician's name and contact information.
7. Sign and date the form to validate the order.
8. Submit the completed form to the OHSU imaging department either electronically or via fax.

Who needs OHSU Physician Order Form for Imaging Services?

1. Patients requiring diagnostic imaging services, such as X-rays, MRIs, or CT scans.
2. Physicians who are referring patients for imaging services within OHSU.
3. Administrative staff handling the scheduling and management of imaging appointments.

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What is OHSU Physician Order Form for Imaging Services?

The OHSU Physician Order Form for Imaging Services is a document used by healthcare providers to request imaging studies and services at Oregon Health & Science University. It outlines the specific imaging procedures needed for a patient's diagnosis and treatment.

Who is required to file OHSU Physician Order Form for Imaging Services?

Healthcare providers, such as physicians and nurse practitioners, are required to file the OHSU Physician Order Form for Imaging Services when ordering imaging procedures for their patients.

How to fill out OHSU Physician Order Form for Imaging Services?

To fill out the OHSU Physician Order Form for Imaging Services, providers should complete all required fields, including patient information, clinical history, the specific imaging studies requested, and any additional notes or instructions relevant to the patient's care.

What is the purpose of OHSU Physician Order Form for Imaging Services?

The purpose of the OHSU Physician Order Form for Imaging Services is to ensure that healthcare providers communicate the necessity and details of imaging studies to the imaging department, facilitating appropriate patient care and accurate diagnosis.

What information must be reported on OHSU Physician Order Form for Imaging Services?

The information that must be reported on the OHSU Physician Order Form for Imaging Services includes the patient's personal details (name, date of birth, medical record number), the relevant clinical history, specific imaging tests requested, and the provider's signature and contact information.