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Diagnostic Imaging Request Patients name: ___Gradate of birth: ULTRASOUNDPatient contact number: ___FLUOROSCOPYReason for exam: ___CT (Cat Scan)Available at McAllen Medical PlazaNUCLEAR MEDICINE Available

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How to fill out diagnostic imaging request

01

Obtain the correct form for the diagnostic imaging request from the respective healthcare provider or facility.

02

Fill out the patient's personal information such as name, date of birth, and contact details.

03

Provide relevant medical history and reason for the diagnostic imaging request.

04

Specify the type of imaging required (e.g. X-ray, MRI, CT scan).

05

Ensure all information is accurate and complete before submitting the request.

Who needs diagnostic imaging request?

01

Patients who require further evaluation or diagnosis of their medical condition.

02

Healthcare providers who need to assess a patient's internal structures or organs.

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What is diagnostic imaging request?

A diagnostic imaging request is a form filled out by a healthcare provider to request imaging tests for a patient.

Who is required to file diagnostic imaging request?

Healthcare providers, such as doctors and specialists, are required to file diagnostic imaging requests.

How to fill out diagnostic imaging request?

Diagnostic imaging requests are typically filled out electronically or on paper, providing patient information, reason for the test, and type of imaging needed.

What is the purpose of diagnostic imaging request?

The purpose of a diagnostic imaging request is to order specific imaging tests to help diagnose and treat medical conditions.

What information must be reported on diagnostic imaging request?

Patient demographics, medical history, reason for the test, type of imaging requested, and referring provider information must be reported on a diagnostic imaging request.

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