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CT ICONOGRAPHY (CTC) REQUISITION ORDERINGPHYSICIAN Reset PATIENTNAME: Name: DOB: Signature: HAN: HOMOPHONE: Copy to: CELLPHONE: ADDRESS: DepartmentofDiagnosticImaging Date(dd/mm/by): Tel.6139697400×2860(BGH)

How to fill out ct colonography ctc requisition

How to fill out ct colonography ctc requisition:

1. Begin by filling out your personal information, including your full name, date of birth, and contact information. Make sure all the details are accurate and up-to-date.
2. Next, provide your medical history, including any pre-existing conditions or allergies that may be relevant to the CT colonography. This will help the healthcare provider assess your suitability for the procedure.
3. Indicate the reason for the CT colonography requisition. If you have specific symptoms, mention them here. It's essential to provide a clear and concise description to aid the healthcare provider in understanding your condition.
4. If you have any relevant family history of gastrointestinal diseases or colon cancer, make sure to disclose it in the appropriate section of the requisition form. This information can help the healthcare provider evaluate your risk factors.
5. Provide your referring physician's details, including their name, address, and contact information. This ensures that the results of your CT colonography can be sent directly to your doctor for further evaluation and discussion.
6. If you have any specific requests or concerns regarding the procedure, mention them in the appropriate section. Communication with your healthcare provider is crucial in addressing all your needs and ensuring a safe and effective CT colonography.
7. Finally, review the filled-out requisition form to ensure all the information is correct. Double-check your personal details, medical history, reason for the requisition, and referring physician's information for accuracy.

Who needs ct colonography ctc requisition:

1. Individuals who are at an increased risk of colorectal cancer, such as those with a family history of the disease or genetic predisposition, may require a ct colonography ctc requisition.
2. Patients experiencing symptoms such as persistent abdominal pain, rectal bleeding, sudden weight loss, or changes in bowel habits may also need a ct colonography requisition to assess the possible causes of these symptoms.
3. As a screening tool, some healthcare providers recommend ct colonography for routine colorectal cancer screening in individuals over a certain age or with specific risk factors. Therefore, those who fall into the recommended screening guidelines may require a ct colonography ctc requisition.

For pdfFiller’s FAQs

What is ct colonography ctc requisition?

CT colonography (CTC) requisition is a form that requests a computed tomography scan of the colon to screen for polyps, tumors, or other abnormalities.

Who is required to file ct colonography ctc requisition?

Healthcare providers such as clinicians, gastroenterologists, or radiologists are required to file CT colonography CTC requisition.

How to fill out ct colonography ctc requisition?

CT colonography CTC requisition can be filled out by providing patient information, reason for the scan, and any relevant medical history.

What is the purpose of ct colonography ctc requisition?

The purpose of CT colonography CTC requisition is to facilitate the process of scheduling a CT scan of the colon for screening or diagnostic purposes.

What information must be reported on ct colonography ctc requisition?

CT colonography CTC requisition must include patient demographics, referring physician information, clinical indications for the scan, and any relevant medical history.

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