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For DI Use Only Screen by: ___ Scan Date: ___ Scan time: ___ Arrival Time: ___115 Delhi Street Guelph, ON N1E 4J4 Tel: 519.837.6413 Fax: 519.766.9982 www.gghorg.caECHOCARDIOGRAM REQUISITION Date of
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How to fill out echocardiogram requisition
How to fill out echocardiogram requisition
01
Fill out the patient's demographic information including name, date of birth, and gender.
02
Provide information about the referring physician and their contact details.
03
Specify the reason for the echocardiogram and any relevant medical history.
04
Indicate the type of echocardiogram needed (e.g. transthoracic, transesophageal).
05
Include any additional instructions or specific requests for the echocardiogram.
Who needs echocardiogram requisition?
01
Patients who have symptoms or risk factors for heart disease may need an echocardiogram requisition.
02
Physicians, cardiologists, and other healthcare providers may also require an echocardiogram requisition to aid in diagnosis and treatment.
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What is echocardiogram requisition?
Echocardiogram requisition is a medical order or request for an echocardiogram test, which is an ultrasound of the heart.
Who is required to file echocardiogram requisition?
Typically, a cardiologist or a healthcare provider will file an echocardiogram requisition for a patient.
How to fill out echocardiogram requisition?
To fill out an echocardiogram requisition, the healthcare provider must include patient information, reason for the test, and any relevant medical history.
What is the purpose of echocardiogram requisition?
The purpose of an echocardiogram requisition is to assess and diagnose heart conditions by using ultrasound imaging.
What information must be reported on echocardiogram requisition?
Information such as patient name, date of birth, referring physician, reason for test, and any relevant medical history must be reported on an echocardiogram requisition.
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