Get the free UROLOGY REQUISITION - Eastern Carolina Pathology

???000001A UROLOGY REQUISITION CUSTOMER SERVICE 1(866) 572.8452 or (252) 234.2841 FAX (252) 234.9270 2693B Forest Hills Road, Wilson, NC 27893 PHYSICIAN INFORMATION PATIENT INFORMATION Last Name Date

How to fill out urology requisition - eastern

How to fill out the Eastern Urology Requisition:

1. Begin by filling out your personal information at the top of the form. This includes your full name, date of birth, and contact information. Make sure to write legibly and include any relevant medical identification numbers.
2. Next, provide details about your referring physician. This includes their name, specialty, and contact information. This information is crucial for communication between your physician and the urology department.
3. Indicate the reason for your visit or the specific urological issue you are experiencing. This helps the urology team to better understand your condition and provide appropriate care.
4. Fill out any relevant medical history information. This may include previous surgeries, medical conditions, allergies, and current medications. Ensure accuracy and provide as much detail as possible to ensure comprehensive care.
5. Provide insurance information, including your insurance provider, policy number, and any required authorizations. This allows the urology department to verify coverage and submit claims on your behalf.
6. Sign and date the form to confirm that the information provided is accurate and complete. This serves as your consent for treatment and allows the urology department to share relevant information with other healthcare providers involved in your care.

Who needs the Eastern Urology Requisition:

1. Individuals with urological issues or symptoms such as urinary tract infections, kidney stones, bladder problems, prostate conditions, or urinary incontinence may require the Eastern Urology Requisition.
2. Patients who have been referred to the Eastern Urology department by their primary care physician, gynecologist, or other healthcare professionals may also need to fill out this requisition.
3. The Eastern Urology Requisition is typically required for new patients seeking urological care or for those who need specialized urological procedures or surgeries.

Remember, it is always best to consult with your healthcare provider or the Eastern Urology department directly for specific instructions on filling out the requisition form.

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What is urology requisition - eastern?

Urology requisition - eastern is a form that needs to be filled out to request urology services in the eastern region.

Who is required to file urology requisition - eastern?

Any healthcare provider or facility in the eastern region requiring urology services is required to file urology requisition - eastern.

How to fill out urology requisition - eastern?

The urology requisition form must be completed with the necessary patient information, requested services, and healthcare provider details.

What is the purpose of urology requisition - eastern?

The purpose of urology requisition - eastern is to request urology services for patients in the eastern region.

What information must be reported on urology requisition - eastern?

Information such as patient demographics, clinical history, requested services, healthcare provider details, and any relevant test results must be reported on urology requisition - eastern.