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Patient Name: ___ Date of Birth: ___ Phone Number: ___INTERVENTIONAL RADIOLOGY CONSULTATION REQUEST (Please submit this form, last clinic note, and patient contact info ) REASON FOR CONSULT (Check
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01
Gather all necessary patient information including medical history, diagnostic imaging results, and current medications.
02
Complete the interventional radiology consultation request form with patient demographics and referring provider information.
03
Indicate the reason for consultation and specify the procedures or interventions being requested.
04
Submit the completed form through the appropriate channels for review and scheduling.

Who needs interventional-radiology-consultation-request?

01
Patients who require minimally invasive procedures or interventions for their medical conditions.
02
Medical providers who want to consult with an interventional radiologist for expert opinion or guidance on treatment options.
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Interventional-radiology-consultation-request is a formal request for a consultation with a radiologist specialized in interventional procedures.
Medical professionals who need guidance or expertise in interventional radiology procedures are required to file the request.
The request form must be completed with patient information, reason for consultation, relevant medical history, and any pertinent imaging studies.
The purpose is to seek advice or recommendations from an interventional radiologist on complex cases or procedures.
Patient demographics, referring physician details, reason for consultation, relevant medical history, current medications, and any relevant imaging studies.
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