Get the free Bone Mineral Density Requisition

This document is a requisition form for requesting a Bone Mineral Density (BMD) exam at Waterloo Wellington Hospitals. It includes sections for patient information, exam information, physician details, and risk factor screenings, as well as contact information for various hospitals in the region.

How to fill out bone mineral density requisition

How to fill out bone mineral density requisition

1. Obtain the bone mineral density requisition form from your healthcare provider or clinic.
2. Fill in the patient's personal information including name, date of birth, and contact details.
3. Indicate the referring physician's information, including their name and contact number.
4. Select the appropriate indication for the bone mineral density test (e.g., osteoporosis risk assessment, fracture history).
5. Specify any relevant medical history, medications, or risk factors for osteoporosis.
6. Sign and date the requisition form to verify accuracy.
7. Submit the completed requisition form to the designated imaging facility.

Who needs bone mineral density requisition?

1. Individuals at risk for osteoporosis, including postmenopausal women, older adults, and those with a history of fractures.
2. People with specific medical conditions or medications that may affect bone health.
3. Patients undergoing long-term steroid treatment or with a family history of osteoporosis.

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What is bone mineral density requisition?

A bone mineral density requisition is a request form used to order a bone density test, which measures the amount of minerals (such as calcium) in the bones to assess bone health.

Who is required to file bone mineral density requisition?

Healthcare providers, such as physicians and specialists, are required to file a bone mineral density requisition for patients who need to undergo a bone density test.

How to fill out bone mineral density requisition?

To fill out a bone mineral density requisition, provide patient information, including name, date of birth, and insurance details, along with the clinical indication for the test and any specific instructions for the technician.

What is the purpose of bone mineral density requisition?

The purpose of a bone mineral density requisition is to facilitate the order and scheduling of a bone density scan, helping to diagnose conditions like osteoporosis and assess fracture risk.

What information must be reported on bone mineral density requisition?

Essential information to report includes patient demographics, physician's details, medical history relevant to bone health, and the indication for the bone density test.