Get the free PET/CT Requisition - St. Joseph's Hospital

PET/CT LAST NAME: Request Form FIRST NAME: D.O.B.: BY / MM / DD St. Joseph's Hospital McMaster Hospital Nuclear Medicine & Molecular Imaging Department Sorbonne Building F-129 50 Charlton Avenue East

How to fill out petct requisition - st

How to fill out a PETCT requisition - ST?

1. Begin by gathering all the necessary information. This includes the patient's personal details such as name, date of birth, gender, and contact information.
2. Next, provide the referring physician's information, including their name, specialty, and contact details. It is important to ensure that the referring physician is authorized to request a PETCT scan, as this helps in maintaining the accuracy and integrity of the test.
3. Specify the reason for the PETCT scan. It could be for diagnostic purposes, monitoring a specific condition, or evaluating the response to a particular treatment. Clearly communicate the clinical question that the PETCT scan aims to address.
4. Indicate the clinical history of the patient. Include relevant medical information such as previous imaging results, current medications, allergies, and any relevant clinical symptoms or concerns. This helps the radiologist interpret the scan accurately and interpret any abnormalities in the context of the patient's overall health.
5. Determine the specific type of PETCT scan required. There are various radiotracers that can be used in PETCT scans, depending on the specific clinical question being asked. Ensure that the appropriate radiotracer is selected.
6. Include any additional instructions or requests for the PETCT scan. This may include specific imaging protocols, patient preparation instructions (such as fasting requirements), or any other relevant information that could assist the radiology team in conducting the scan effectively.
7. Finally, ensure that all the necessary signatures and authorizations are obtained. This includes the patient's consent for the procedure and the referring physician's authorization. Make sure that the requisition form is legible and complete, without any missing information or sections left blank.

Who needs a PETCT requisition - ST?

A PETCT requisition is typically needed by patients who require a PETCT scan based on the clinical judgement of their referring physician. This could include individuals who are suspected to have or are being monitored for various medical conditions, such as cancer, inflammatory diseases, or neurological disorders. The requisition helps in ensuring that the appropriate diagnostic imaging test is conducted and aids in providing valuable information for accurate diagnosis and treatment planning.

For pdfFiller’s FAQs

What is petct requisition - st?

PETCT requisition - ST is a form used to request a positron emission tomography computed tomography (PETCT) scan for a patient.

Who is required to file petct requisition - st?

Medical professionals such as physicians or specialists are required to file a PETCT requisition - ST for their patients.

How to fill out petct requisition - st?

PETCT requisition - ST can be filled out by providing patient information, reason for the scan, any relevant medical history, and other required details.

What is the purpose of petct requisition - st?

The purpose of PETCT requisition - ST is to authorize and request a PETCT scan to diagnose, monitor, or treat a medical condition.

What information must be reported on petct requisition - st?

Information such as patient demographics, referring physician details, clinical indication for the scan, relevant medical history, and any necessary clinical notes must be reported on PETCT requisition - ST.

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