Get Uw Medicine Radiology Order Form 2020-2025

Filling out the UW Medicine Radiology Order Form online can facilitate access to essential radiology services. This guide offers a comprehensive step-by-step approach to help users effectively complete the form with confidence.

Follow the steps to successfully complete the UW Medicine Radiology Order Form

1. Press the ‘Get Form’ button to acquire the form and launch it in the appropriate online editor.
2. Begin by filling out the patient information section. Include the last name, first name, and date of birth of the person requiring the exam. Provide their daytime and evening phone numbers for contact purposes.
3. In the insurance details section, enter the insurance carrier name and any associated authorization or identification numbers. This information is crucial for billing and insurance verification.
4. Indicate the urgency of the appointment by selecting from the options provided: first available appointment, routine, urgent, or STAT. Check the box that corresponds to the patient's condition.
5. Enter the patient’s weight and specify any required interpreter or language services. If the exam is related to workers’ compensation, provide the date of injury and claim number.
6. In the exam information section, clearly state the exact area of interest and the reason for the exam. This helps ensure accurate diagnostics and procedures.
7. Input the ICD-10 code related to the patient's condition. Additionally, choose the appropriate exam type, such as MRI, CT, Ultrasound, etc., and select whether contrast is needed.
8. Complete any notes section, indicating if the exam is considered clinically urgent and include relevant information such as related imaging or prior reports.
9. Finally, ensure that the provider signature section is completed. The provider must sign, print their name, and include their contact number, date, time, and NPI number if this is a first-time referral.
10. After finalizing all details, save the completed form. You can choose to download, print, or share the form as necessary.

Encourage others to complete the UW Medicine Radiology Order Form online for a smooth and efficient process.