Get the free PET/CT Imaging Request - Alberta Health Services

19032 (2014-09). Current Patient Condition. Fax to Diagnostic Imaging; fax numbers listed at http://www.albertahealthservices.ca/diagnosticimaging.

How to fill out petct imaging request

How to fill out a PET/CT imaging request?

1. Start by gathering all necessary patient information, including their full name, date of birth, and contact details. This information is crucial for correctly identifying the patient and ensuring accurate results.
2. Indicate the reason for the PET/CT imaging request. This can range from initial staging, restaging, treatment response assessment, or monitoring of a specific condition. Providing clear and concise details about the purpose of the scan will help guide the radiologist interpreting the results.
3. Specify any relevant medical history or clinical information that may impact the imaging process or interpretation. Include details such as previous surgeries, ongoing medications, and any known allergies or adverse reactions.
4. Provide any specific instructions or special requirements for the PET/CT scan. This may include fasting instructions, medication restrictions, or specific imaging protocols requested by the referring physician.
5. Include any additional imaging or test results that may aid in the interpretation of the PET/CT scan. This can include previous radiology reports, laboratory results, or pathology findings.
6. Clearly indicate the referring physician's contact information and signature. This is necessary for facilitating communication between the radiologist and the referring doctor if any additional information or clarification is required.

Who needs a PET/CT imaging request?

1. Patients who require accurate staging of cancerous tumors to determine the extent of disease spread.
2. Individuals who are undergoing treatment for cancer and require periodic restaging to assess treatment response.
3. Patients with suspected recurrent or metastatic disease who are in need of further evaluation.
4. Individuals with neurologic disorders, such as epilepsy or Alzheimer's disease, who may benefit from PET/CT imaging to aid in diagnosis or disease progression monitoring.
5. Patients with cardiac conditions, such as myocardial perfusion, to assess blood flow and determine the presence of any abnormalities.

Remember, it is essential to consult with a qualified healthcare professional for specific indications and guidelines regarding PET/CT imaging requests.

For pdfFiller’s FAQs

What is petct imaging request?

A PET-CT imaging request is a form or document that is used to request a PET-CT scan for a patient.

Who is required to file petct imaging request?

PET-CT imaging requests are typically filed by a referring physician or healthcare provider who believes a patient would benefit from a PET-CT scan.

How to fill out petct imaging request?

To fill out a PET-CT imaging request, the requesting physician must provide the necessary patient information, reason for the scan, and any relevant medical history.

What is the purpose of petct imaging request?

The purpose of a PET-CT imaging request is to determine the presence and location of abnormalities or diseases within the body.

What information must be reported on petct imaging request?

The information reported on a PET-CT imaging request typically includes patient demographics, clinical history, and reason for the scan.

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