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XRAY REQUISITION PLEASE ATTACH A COPY OF PATIENTS FACE SHEET & DRS ORDER MODESTO MOBILE IMAGES SERVICESTel: 2098146239 Fax: 9166230411DATE___/___/___RM#___PATIENT FIRST & LAST NAME___DOB___/___/___
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01
Gather patient information such as name, date of birth, and medical history.
02
Complete the necessary sections on the requisition form including ordering physician information, patient demographics, and desired imaging tests.
03
Double check the information for accuracy and completeness before submitting the requisition.
04
Submit the requisition form to the appropriate department or imaging center for processing.

Who needs requisitions - medical imaging?

01
Patients who have been referred by their healthcare provider for medical imaging tests.
02
Healthcare providers such as doctors, radiologists, and other medical professionals who require imaging tests to diagnose or monitor a medical condition.
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Requisitions in medical imaging are formal requests made by healthcare providers for patients to undergo specific imaging procedures, such as X-rays, MRIs, or CT scans.
Healthcare providers, including doctors, specialists, and sometimes physician assistants or nurse practitioners, are required to file requisitions for medical imaging.
To fill out requisitions for medical imaging, providers should complete all required fields including patient information, procedure details, clinical indications, and their signature, ensuring that all details are accurate and legible.
The purpose of requisitions for medical imaging is to ensure that the appropriate imaging tests are ordered based on clinical needs, facilitate scheduling, and communicate necessary information to imaging staff.
Requisitions must typically include patient demographics (name, date of birth, contact information), ordering provider's details, procedure requested, clinical justification, and any other relevant medical history.
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