
Get Radiology Requisition Form
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How to fill out the Radiology Requisition Form online
Filling out the Radiology Requisition Form online is an essential step in ensuring that patients receive the necessary imaging services. This guide will provide you with a clear, step-by-step approach to completing each section of the form accurately and efficiently.
Follow the steps to complete the Radiology Requisition Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the patient's name in the designated fields. Ensure to enter the last name first, followed by the first name.
- Next, provide the date of birth (DOB) and the patient's sex in the specified areas. This information is crucial for patient identification.
- Input the patient's phone number to facilitate communication regarding the exam.
- Fill in the name of the referring physician who is requesting the exam. This section is essential for proper documentation.
- Complete the clinical history/diagnosis section carefully. Provide relevant symptoms, signs, or abnormal test results that justify the medical necessity for the exam. Avoid vague terms like 'rule out' or 'suspected'.
- Indicate the urgency of the exam by selecting either ‘Routine’ or ‘STAT’. If applicable, also specify if you would like the reports to be held for a call or sent via fax, providing the necessary contact information.
- Select the type of exam requested by checking the appropriate boxes under the available categories, such as general x-ray, fluoroscopy, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Be sure to list any specific views needed.
- If the exam requires IV contrast, indicate whether it should be given with or without contrast.
- Answer whether anesthesia is needed for the procedure by marking the appropriate option.
- Finally, ensure that the form is signed by the physician, including the date and time of signing. This signature is necessary for the requisition to be valid.
- Once all sections are filled out accurately, save your changes. You can choose to download, print, or share the form as needed.
Complete your Radiology Requisition Form online today for efficient scheduling!
When completing a requisition form, include essential details such as the requestor's name, department, and purpose of the requisition. For a Radiology Requisition Form, also provide patient identifiers, details of the requested imaging, and any specific diagnosis related to the request. Accurate information is critical for efficient processing.
Fill Radiology Requisition Form
This section MUST be completed if requesting CT. Is Kidney Function abnormal? H Yes h No. Has patient had L-spine surgery? No Appointment Needed GENERAL X-RAY. Scheduled Appointment Required. A radiology requisition form is used to order medical imaging for a patient. General Radiology (X-Ray). Find all medical imaging requisition forms in PDF to refer a patient to the Joint Department of Medical Imaging. Download a form now. The requisition form, often called a referral form, is essential for effective communication between your doctor and the radiology team. Payment is required at the time of service unless other arrangements have been made.
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