Get the free PET-CT Patient request form

Imaging request form Royal Brompton Hospital For direct referrals for imaging exams from outside organisationsPatient information Surname First name Date of birth Phone Mobile Address Postcode NHS

How to fill out pet-ct patient request form

How to fill out pet-ct patient request form

1. Obtain the pet-ct patient request form from the healthcare provider or radiology department.
2. Fill in the patient's personal information including name, date of birth, and contact information.
3. Provide details about the referring healthcare provider such as name, specialty, and contact information.
4. Fill in the clinical indication for the pet-ct scan including the reason for the exam and any relevant medical history.
5. Specify any relevant medications the patient is currently taking.
6. Sign and date the form, ensuring all required fields are completed accurately.

Who needs pet-ct patient request form?

1. Patients who have been referred for a pet-ct scan by their healthcare provider.
2. Healthcare providers who are referring patients for pet-ct scans.

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What is pet-ct patient request form?

The PET-CT patient request form is a document used to request a positron emission tomography-computed tomography scan for a patient.

Who is required to file pet-ct patient request form?

Medical professionals such as doctors or radiologists are required to file the PET-CT patient request form on behalf of the patient.

How to fill out pet-ct patient request form?

The form is usually filled out by providing the patient's personal information, medical history, reason for the scan, and any other relevant details.

What is the purpose of pet-ct patient request form?

The purpose of the PET-CT patient request form is to facilitate the scheduling and performance of a PET-CT scan for diagnostic or treatment purposes.

What information must be reported on pet-ct patient request form?

The form typically requires information such as patient's name, date of birth, medical history, reason for the scan, referring physician's details, and any relevant medical conditions.