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Cdiagnostics (a division of Chealth) Suite 210, 1016 68 Avenue SW Calgary, AB T2V 4J2 Ph: (403) 5410033 Fx: (403) 5410032 www.chealth.caDIAGNOSTIC SERVICE REQUISITION PATIENT INFORMATION (attach patient

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How to fill out diagnostic service requisition

01

Obtain the appropriate diagnostic service requisition form from the relevant healthcare facility.

02

Fill in all required personal information including name, date of birth, contact information, and insurance details.

03

Provide information about the specific tests or procedures being requested by your healthcare provider.

04

Obtain any necessary signatures, including your own and that of your healthcare provider.

05

Ensure that all sections of the form are completed accurately and legibly.

06

Submit the completed diagnostic service requisition form to the designated department or lab for processing.

Who needs diagnostic service requisition?

01

Patients who have been referred by their healthcare provider for specific diagnostic tests or procedures.

02

Healthcare providers who are ordering diagnostic services on behalf of their patients.

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What is diagnostic service requisition?

Diagnostic service requisition is a formal request for specific medical tests or procedures to be performed on a patient.

Who is required to file diagnostic service requisition?

Healthcare providers such as doctors, nurses, or medical technicians are typically required to file a diagnostic service requisition.

How to fill out diagnostic service requisition?

Diagnostic service requisition forms can be filled out by providing the patient's personal information, medical history, and the specific tests or procedures requested.

What is the purpose of diagnostic service requisition?

The purpose of diagnostic service requisition is to ensure that necessary medical tests or procedures are performed accurately and in a timely manner.

What information must be reported on diagnostic service requisition?

Information such as patient name, date of birth, contact information, medical insurance details, requested tests or procedures, and healthcare provider's signature may need to be reported on diagnostic service requisition.

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