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EMPLOYEES STATE INSURANCE HOSPITAL Rohini, Sector15, New Delhi 110085 Website: www.esic.nic.inF. No. 115/U/16/30/radiology/13Ph . 27860004 Fax. 27553098Dated 01 .09.14 Fax:27553098M/S.___ ___ ___

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How to fill out 115u1630radiology13

01

Obtain the form 115u1630radiology13.

02

Fill out the patient's name, date of birth, and medical record number.

03

Provide details of the radiology procedure being performed.

04

Include the ordering physician's name and contact information.

05

Sign and date the form to certify its accuracy.

Who needs 115u1630radiology13?

01

Patients who are scheduled to undergo a radiology procedure.

02

Healthcare providers who are ordering or performing the radiology procedure.

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What is 115u1630radiology13?

115u1630radiology13 is a specific form or code used in the medical field related to radiology services.

Who is required to file 115u1630radiology13?

Radiology facilities and practitioners are required to file 115u1630radiology13 for billing and reporting purposes.

How to fill out 115u1630radiology13?

115u1630radiology13 should be filled out with accurate patient information, procedure codes, and any other required details related to radiology services provided.

What is the purpose of 115u1630radiology13?

The purpose of 115u1630radiology13 is to track and report radiology services provided to patients for billing and insurance purposes.

What information must be reported on 115u1630radiology13?

Information such as patient demographics, date of service, type of procedure performed, and relevant diagnosis codes must be reported on 115u1630radiology13.

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