Get Outpatient Physician Order Form - High Point Regional 2020-2025

Filling out the Outpatient Physician Order Form is an essential step in ensuring that patients receive the necessary imaging services. This guide provides a detailed walkthrough of each section of the form to assist users in completing it accurately and efficiently.

Follow the steps to complete the outpatient physician order form online.

1. Press the ‘Get Form’ button to access the form and open it in the designated editing interface.
2. Begin by entering the patient's information. Fill in the patient’s name, date of birth, phone number, and select the gender by circling either 'Male' or 'Female'. Also, provide the patient’s Social Security number and the date/time of the exam.
3. In the insurance information section, input the primary insurance company name, policy number, and group number. If applicable, provide the secondary insurance information in the same format.
4. Indicate whether pre-authorization or notification is required by circling 'PreAuth', 'PreCert', 'Notif', or 'N/A' and provide the corresponding number if necessary.
5. Specify the reason for testing by filling out the reason for the exam and ensure to include an ICD-9 code. Note: using phrases like 'rule out' or 'follow-up' is not permitted.
6. Select the desired examination type and corresponding CPT code from the available options provided in the section. Circle the appropriate exam and write down the corresponding CPT code.
7. Complete any additional details if necessary, ensuring to provide clear and concise information.
8. Once the form is filled out completely, review all sections for accuracy. After confirming that all information is correct, you may choose to save your changes, download, print, or share the completed form as needed.

Start completing the outpatient physician order form online today to ensure timely and accurate patient care.