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200 Fletcher Crescent Alliston, Ontario L9R 1W7 Tel: 7054356281Patient Notified ___ Dart Done ___ Prep Explained ___No ___APPOINTMENT DATE AND TIME: ___CT SCAN REQUISITION Name:Health Card #:Address:
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How to fill out ct scan requisition
How to fill out ct scan requisition
01
Start with patient identification: Fill in the patient's full name, date of birth, and medical record number.
02
Provide referring physician details: Include the name of the referring physician and contact information.
03
Indicate the type of CT scan needed: Specify the body part or area to be scanned (e.g., abdomen, chest, head).
04
Include clinical indications: Write a brief description of the patient's symptoms or reasons for the scan.
05
List any relevant medical history: Note any previous or ongoing medical conditions that may affect the scan.
06
Specify any special instructions: Mention if there are any specific requirements, such as contrast use.
07
Sign and date the requisition: Ensure the requisition is signed by the referring physician along with the date.
Who needs ct scan requisition?
01
Patients with unexplained symptoms that require further investigation.
02
Individuals being evaluated for conditions like tumors, injuries, or infections.
03
Patients requiring follow-up imaging for previously diagnosed medical issues.
04
Individuals who need a CT scan for pre-operative assessments.
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What is ct scan requisition?
A CT scan requisition is a formal document that requests a CT scan to be performed on a patient, detailing the purpose of the scan and necessary patient information.
Who is required to file ct scan requisition?
Typically, a licensed healthcare provider, such as a physician or a specialist, is required to file a CT scan requisition on behalf of the patient.
How to fill out ct scan requisition?
To fill out a CT scan requisition, a healthcare provider must provide patient information, relevant medical history, specific details about the scan requested, and any required coding or insurance information.
What is the purpose of ct scan requisition?
The purpose of a CT scan requisition is to formally document the request for a CT scan, ensure that appropriate diagnostic imaging is performed, and facilitate communication between healthcare providers and imaging centers.
What information must be reported on ct scan requisition?
The requisition must include patient demographic details, clinical information, specific reasons for the CT scan, and any pertinent medical history that could affect the scan.
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