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Get Uchealth Radiology Imaging Request Form
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How to fill out the UCHealth Radiology Imaging Request Form online
The UCHealth Radiology Imaging Request Form is essential for requesting imaging services. This guide provides detailed instructions to assist you in completing the form accurately and efficiently online.
Follow the steps to complete the UCHealth Radiology Imaging Request Form successfully.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the Patient Information section. Fill in all required fields, including the patient’s name, date of birth, gender, address, city, state, and zip code.
- Next, proceed to the Insurance Information section. Ensure completion of all fields, entering the member ID, group number, and insurance provider accurately.
- Move to the Referring Provider Information section. Complete all required fields, including the provider's first name, NPI, signature, date, clinic name/address, office contact phone number, provider direct cell/pager number, and provider fax number.
- In the Imaging Request Form section, check all applicable imaging types such as CT, MRI, Nuclear Medicine, and Diagnostic Imaging. Provide additional details like CPT codes, body part, diagnosis codes (ICD 10), signs/symptoms, and any specified scan requirements.
- Indicate whether the scan is okay to be altered by the radiologist, and answer the question regarding patient claustrophobia. If applicable, specify the need for oral sedative or anesthesia.
- Select the appropriate UCHealth imaging facility based on the options provided.
- After ensuring all required fields are completed, you can save changes, download, print, or share the form as needed.
Complete the UCHealth Radiology Imaging Request Form online today for efficient processing.
Related links form
Writing a radiology request involves specifying the patient's information, the recommended imaging study, and the clinical reason for the request. It is important to ensure that all details are clear and concise to avoid any misunderstandings. By using the UCHealth Radiology Imaging Request Form, you can efficiently document this information and expedite the request process.
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