Get the free RADIOLOGY DEPARTMENT Exam Requisition

DEPARTMENT OF RADIOLOGY Imaging Exam Requisition PATIENT NAME (Last) ___ (First)___ DOB ___/___/___ SEX___ PATIENT PHONE# ___ DIAGNOSIS (Required) ___*Reason for exam should establish medical necessity

How to fill out radiology department exam requisition

How to fill out radiology department exam requisition

1. Obtain the patient's information including name, date of birth, and medical record number.
2. Indicate the type of exam needed such as X-ray, MRI, CT scan, ultrasound, etc.
3. Provide details about the specific area or body part that needs to be examined.
4. Include any relevant clinical history or symptoms that might help the radiologist make an accurate diagnosis.
5. Specify any special instructions for the exam such as fasting requirements or medication restrictions.
6. Have the requesting healthcare provider sign and date the requisition form before submitting it to the radiology department.

Who needs radiology department exam requisition?

1. Patients who have been referred by their healthcare provider for a radiology exam.
2. Healthcare providers such as doctors, physician assistants, or nurse practitioners who are requesting the exam for their patients.
3. Hospital staff who assist in scheduling and coordinating radiology exams for patients.

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What is radiology department exam requisition?

A radiology department exam requisition is a formal request for radiologic imaging services such as X-rays, MRIs, or CT scans, usually submitted by a healthcare provider.

Who is required to file radiology department exam requisition?

The requisition must typically be filed by healthcare providers such as doctors, nurse practitioners, or physician assistants who are ordering the radiology exam for a patient.

How to fill out radiology department exam requisition?

To fill out the requisition, the healthcare provider needs to provide patient information, the type of exam requested, clinical indications, and any relevant medical history.

What is the purpose of radiology department exam requisition?

The purpose of the radiology department exam requisition is to communicate the need for imaging, ensure appropriate use of radiology resources, and facilitate patient care.

What information must be reported on radiology department exam requisition?

The requisition must include patient demographics, ordering provider's information, the specific exam needed, clinical reason for the exam, and any pertinent medical history.