Get the free Ultrasound Request - Alberta Health Services

Ultrasound Request Fax to Diagnostic Imaging; fax numbers listed at http://www.albertahealthservices.ca/diagnosticimaging Urgent/Emergent requests must be Preferred Facility discussed by direct consultation

How to fill out ultrasound request - alberta

How to fill out an ultrasound request - Alberta:

1. Obtain the ultrasound request form: The first step is to obtain the ultrasound request form from the healthcare provider who is referring you for the ultrasound. This form may be provided to you in person or may be available for download from the healthcare facility's website.
2. Fill in personal information: Begin by filling in your personal information on the form. This typically includes your full name, date of birth, address, phone number, and healthcare number. Ensure that all the information is legible and accurate.
3. Specify the type of ultrasound: Indicate the specific type of ultrasound that is being requested. For example, if it is a prenatal ultrasound, specify whether it is for a dating scan or an anatomy scan. If it is for a different purpose, such as abdominal or pelvic imaging, provide the necessary details.
4. Provide relevant medical history: Describe any relevant medical history that may assist the ultrasound technician in understanding your condition or reason for the ultrasound. This may include previous surgeries, medical conditions, or any ongoing treatments.
5. Attach referral information: If you have received a referral from a healthcare provider, attach it to the ultrasound request form. The referral may include additional information or instructions for the technician performing the ultrasound.
6. Complete insurance or billing information: If applicable, provide your insurance or billing information on the form. This may include the name of your insurance provider, policy number, and any required authorization codes. If you are self-paying, include the necessary payment information.
7. Review and sign the form: Carefully review all the information you have provided on the form, ensuring its accuracy and completeness. Once you are satisfied with the details, sign the form to confirm that you authorize the ultrasound request.
8. Submit the form: Return the completed ultrasound request form to the healthcare facility or provider who referred you for the ultrasound. Follow any specific instructions provided by your healthcare provider regarding how to submit the form, such as delivering it in person, sending it by mail, or submitting it electronically.
9. Wait for confirmation: After submitting the ultrasound request form, you will typically receive confirmation of your appointment or further instructions. This may be communicated through a phone call, email, or written confirmation letter.

Who needs an ultrasound request - Alberta?

1. Pregnant individuals: Pregnant individuals may require an ultrasound request in Alberta to monitor the development of the fetus, assess the health of the pregnancy, or diagnose any potential complications.
2. Individuals with specific medical conditions: Individuals with specific medical conditions such as abdominal pain, infertility issues, or suspected abnormalities in organs or tissues may need an ultrasound request in Alberta to aid in diagnosis or treatment.
3. Patients referred by healthcare providers: Healthcare providers may request an ultrasound for their patients as part of routine check-ups, follow-ups, or to investigate specific symptoms or concerns.
4. Individuals seeking preventive or screening measures: Some individuals may opt for preventive or screening ultrasounds to detect potential health issues before they cause symptoms. This may include screenings for certain cancers, heart conditions, or other diseases.

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