Get the free PET/CT Imaging Request Form

AM NHS Long PET CT Pat Req FRM Sep13aw:NHS FAQ Mar 08 30/09/2013 16:22-Page 1 PET/CT Patient Request Form Please send completed request forms along with previous relevant imaging reports to: Alliance

How to fill out petct imaging request form

How to fill out a PET/CT imaging request form:

1. Start by entering the patient's personal information, including their full name, date of birth, and contact details. This information is important for identifying the patient and contacting them if necessary.
2. Next, provide the patient's relevant medical history, such as any existing conditions, allergies, or previous surgeries. This information helps the healthcare provider understand the patient's background and any potential risks or contraindications.
3. Indicate the reason for the PET/CT imaging request. Specify the symptoms, concerns, or specific areas of the body that require evaluation. This information helps the healthcare provider determine the appropriate tests and protocols to be followed during the imaging procedure.
4. Specify the requested scan type or protocol. PET/CT imaging can be done for various purposes, such as cancer detection or monitoring treatment response. In this section, indicate whether a specific tracer or radiopharmaceutical is necessary for the scan.
5. If the patient has any recent laboratory or diagnostic test results that are relevant to the imaging request, include them in this section. These additional test results can provide valuable information for the interpreting physician and aid in the accurate diagnosis of the patient's condition.
6. Additionally, indicate any specific preparations or instructions the patient needs to follow prior to the imaging procedure. This may include fasting for a certain number of hours, avoiding certain medications or substances, or any other relevant instructions.
7. Lastly, provide the referring physician's information, including their name, contact details, and any specific requirements they may have for the imaging request.

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What is petct imaging request form?

The PET/CT imaging request form is a document used to request a positron emission tomography/computed tomography scan for a patient.

Who is required to file petct imaging request form?

Doctors, oncologists, or other healthcare providers are required to fill out and file the PET/CT imaging request form for their patients.

How to fill out petct imaging request form?

The PET/CT imaging request form is typically filled out by providing patient information, clinical history, reason for the scan, and any relevant medical records.

What is the purpose of petct imaging request form?

The purpose of the PET/CT imaging request form is to provide detailed information about the patient and the medical necessity for the scan to ensure proper diagnosis and treatment.

What information must be reported on petct imaging request form?

The PET/CT imaging request form typically requires information such as patient demographics, clinical history, referring physician information, reason for the scan, relevant lab results, and medical records.