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PET/CT/PSA Scheduling Form
881 Their Parkway
Medford, OR 97504Scheduling: (541) 6080350
Scheduling fax: (541) 6080376PATIENT INFORMATION
Patient Name___ Age:___ DOB: ___
MaleFemaleHt. ___ Wt.___SS#
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How to fill out petct scheduling form
How to fill out petct scheduling form
01
Contact the PET/CT facility to schedule an appointment.
02
Provide your personal information such as name, date of birth, and contact details.
03
Provide information about your medical history and any relevant medical conditions.
04
Follow any instructions given by the facility regarding preparation for the scan, such as fasting or avoiding certain medications.
05
Confirm the date and time of your appointment, and make any necessary arrangements to attend.
Who needs petct scheduling form?
01
Individuals who have been recommended to undergo a PET/CT scan by their healthcare provider.
02
Patients who are monitoring the progression of a medical condition or treatment response.
03
Individuals who are participating in clinical trials or research studies that require PET/CT imaging.
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What is petct scheduling form?
The PETCT scheduling form is a document used to report the scheduling of a PET/CT scan, detailing patient information and the specifics of the imaging procedure.
Who is required to file petct scheduling form?
Healthcare providers and facilities conducting PET/CT scans are required to file the PETCT scheduling form for patients undergoing the procedure.
How to fill out petct scheduling form?
To fill out the PETCT scheduling form, collect the necessary patient information, including name, date of birth, insurance details, and the specifics of the PET/CT scan being ordered, then submit it as required by applicable guidelines.
What is the purpose of petct scheduling form?
The purpose of the PETCT scheduling form is to ensure accurate and efficient scheduling of PET/CT scans, facilitate patient management, and streamline communication between healthcare providers.
What information must be reported on petct scheduling form?
The information that must be reported on the PETCT scheduling form includes patient demographics, medical history, details of the procedure, referring physician information, and insurance data.
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