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CT REQUISITION ORDERINGPHYSICIAN Reset PATIENTNAME: Name: DOB: Signature: HAN: HOMOPHONE: Copy to: CELLPHONE: ADDRESS: DepartmentofDiagnosticImaging Date(dd/MMM/by): Tel.6139697400×2860(BGH) FAX6139695561

How to fill out departmentofdiagnosticimaging dateddmmmyy - qhc

How to Fill Out Department of Diagnostic Imaging dateddmmmyy:

1. Start by gathering all the necessary information and forms needed to fill out the Department of Diagnostic Imaging dateddmmmyy. This may include your personal information, medical history, and any relevant documents or test results.
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3. Begin filling out the form by providing your personal information. This may include your full name, address, contact information, and date of birth. Double-check the accuracy of your information to avoid any mistakes.
4. Next, provide any required medical information. This may involve listing any previous diagnoses, medications you are currently taking, or any allergies you have. Be thorough and concise in your answers to ensure accuracy.
5. If there are any specific questions or sections related to the Diagnostic Imaging department, answer them accordingly. This may include providing details about the specific imaging procedure you are undergoing or any additional information requested.
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Who needs the Department of Diagnostic Imaging dateddmmmyy:

1. Individuals who require diagnostic imaging procedures such as X-rays, CT scans, MRIs, or ultrasounds. These procedures are often used to diagnose and monitor various medical conditions.
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Remember, it is important to follow the specific instructions provided in the Department of Diagnostic Imaging dateddmmmyy form and seek clarification if needed. Accuracy and thoroughness in filling out these forms are crucial for effective diagnosis and treatment planning.

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