Get the free Dotatate Pet/ct Patient Referral

This form is used for patient referrals to the Theranostics and Nuclear Medicine Department at St Vincent’s Hospital for Whole Body 68Ga-DOTA-peptide PET studies, required for diagnosing gastro-entero-pancreatic

How to fill out dotatate petct patient referral

How to fill out dotatate petct patient referral

1. Obtain the patient's medical history and relevant clinical information.
2. Ensure that the referral form is current and appropriate for the DOTATATE PET/CT procedure.
3. Complete the patient's personal details, including name, date of birth, and health insurance information.
4. Indicate the reason for referral, specifying the clinical indications for the DOTATATE PET/CT scan.
5. Check for any contraindications or special instructions related to the patient's health status.
6. Ensure all necessary signatures from the referring physician are provided on the form.
7. Submit the referral to the appropriate imaging facility along with any relevant supplementary documents.

Who needs dotatate petct patient referral?

1. Patients with suspected neuroendocrine tumors or other types of malignancies that exhibit somatostatin receptor expression.
2. Individuals with a history of neuroendocrine tumors requiring evaluation for treatment response or disease progression.
3. Patients needing assessment for potential metastasis from primary tumors, particularly in cases related to carcinoid syndrome.

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What is dotatate petct patient referral?

Dotatate PET-CT patient referral is a clinical request for a positron emission tomography-computed tomography scan using the radiotracer DOTATATE, primarily utilized for diagnosing and managing neuroendocrine tumors.

Who is required to file dotatate petct patient referral?

Typically, a licensed healthcare provider such as a physician or specialist in oncology or nuclear medicine is required to file a dotatate PET-CT patient referral.

How to fill out dotatate petct patient referral?

To fill out a dotatate PET-CT patient referral, a healthcare provider must complete the referral form with patient information, clinical indications for the scan, and any necessary authorizations or insurance details.

What is the purpose of dotatate petct patient referral?

The purpose of a dotatate PET-CT patient referral is to identify and evaluate neuroendocrine tumors, guide treatment decisions, and monitor disease progression.

What information must be reported on dotatate petct patient referral?

The dotatate PET-CT patient referral must include patient demographic details, clinical history, specific indications for the scan, and the referring physician's information.