Get the free INTERVENTIONAL RADIOLOGY REFERRAL FORM Fax to 519-646 ...

St. Josephs Hospital Diagnostic Imaging Centre, Room C0200 268 Grosvenor St., PO Box 5777, Stn. B London, ON N6A 4V2 Tel. 5196466044INTERVENTIONAL RADIOLOGY REFERRAL FORM Fax to 51964662041.Patient

How to fill out interventional radiology referral form

How to fill out interventional radiology referral form

1. Obtain the interventional radiology referral form from your hospital or clinic.
2. Fill out patient information including name, age, and contact details.
3. Indicate the referring physician's name and contact information.
4. Provide detailed medical history relevant to the condition being referred.
5. Specify the type of interventional procedure needed (e.g., angiography, biopsy).
6. Include any pertinent imaging studies or diagnostic results with the referral.
7. Note any allergies or pre-existing conditions that may affect the procedure.
8. Sign and date the form.
9. Submit the completed form to the interventional radiology department.

Who needs interventional radiology referral form?

1. Patients experiencing conditions such as vascular issues, tumors, or chronic pain might need a referral.
2. Physicians requiring specialized imaging or minimally invasive treatments for their patients.
3. Individuals seeking advanced diagnostic procedures like catheter placements or embolizations.

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What is interventional radiology referral form?

The interventional radiology referral form is a document used by healthcare providers to refer patients for interventional radiology procedures, ensuring proper evaluation and authorization before treatment.

Who is required to file interventional radiology referral form?

Healthcare providers, such as primary care physicians and specialists, are required to file the interventional radiology referral form when recommending a patient for interventional radiology services.

How to fill out interventional radiology referral form?

To fill out the interventional radiology referral form, complete the patient's personal information, the specific procedure requested, clinical indications, and any relevant medical history before submitting it to the interventional radiology department.

What is the purpose of interventional radiology referral form?

The purpose of the interventional radiology referral form is to facilitate communication between referring physicians and interventional radiologists, ensuring that all necessary information is provided for appropriate patient management.

What information must be reported on interventional radiology referral form?

The interventional radiology referral form must report information such as patient demographics, medical history, reason for referral, details of the requested procedure, and any relevant diagnostic images.