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AHMANSONBIOLOGICALIMAGINGCENTER UCLASCHOOLOFMEDICINE NUCLEARMEDICINEDIVISION ANGELES,CA900956942 APPLICATIONFORNUCLEARMEDICINERESIDENCY Iamapplyingforadmissionasaresident inNuclearMedicinefortheperiod: I.PERSONALINFORMATION Name: PhDDODateofBirth: Birthplace:toLastFirstMiddleOtherUSSocialSecurity#: PermanentAddress:Age:
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How to fill out nuclear medicine consultation request

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How to fill out nuclear medicine consultation request

01
Obtain the necessary referral or prescription from a qualified healthcare provider.
02
Gather all relevant medical records, including imaging scans and lab results.
03
Complete the consultation request form with patient demographics, clinical history, and reason for the consultation.
04
Include any pertinent information about allergies, current medications, and previous surgeries.
05
Submit the completed form along with the medical records to the designated nuclear medicine department or specialist.

Who needs nuclear medicine consultation request?

01
Patients who have been referred for further evaluation of a medical condition that may benefit from nuclear medicine imaging studies.
02
Healthcare providers looking to obtain a second opinion or guidance on the appropriate use of nuclear medicine procedures for their patients.
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A nuclear medicine consultation request is a formal document submitted by a physician to request evaluation and diagnostic imaging using nuclear medicine techniques for a patient.
Typically, a licensed physician who is referring a patient for nuclear medicine procedures is required to file the consultation request.
To fill out a nuclear medicine consultation request, a physician must provide patient identification information, medical history, the reason for the consultation, specific tests requested, and relevant clinical information.
The purpose of a nuclear medicine consultation request is to facilitate the appropriate use of nuclear medicine procedures for diagnosis and treatment while ensuring that necessary information is communicated effectively.
The consultation request must include patient demographics, physician information, clinical indications, previously conducted tests, and any pertinent medical history related to the condition being evaluated.
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