Get Eeg Requisition - Joseph Brant Hospital - Josephbranthospital

This guide provides clear and supportive instructions for completing the EEG requisition form for Joseph Brant Hospital. By following these steps, you will ensure that all necessary information is accurately provided to facilitate your appointment with the Medical Diagnostic Unit.

Follow the steps to complete your EEG requisition form

1. Select the ‘Get Form’ button to obtain the EEG requisition form and open it in your preferred editor.
2. Fill in the appointment date and time fields, ensuring that you have made an appointment in advance with the Medical Diagnostic Unit.
3. Enter the referring physician's name in the designated field.
4. Provide the patient's name and complete address, including city and postal code.
5. Record the date of birth by filling in the day, month, and year in the appropriate sections.
6. Enter the home and mobile phone numbers for better communication.
7. Input the health number in the corresponding field.
8. The physician must complete all details regarding clinical diagnosis and the summary of history and physical examination.
9. List any anti-convulsant medications the patient is currently taking.
10. Indicate any other medications the patient is taking, if applicable.
11. Answer the previous EEG test question by selecting 'Yes' or 'No' and indicate where the previous test took place.
12. Check the required test options according to the patient's needs, such as routine EEG, awake, sleep deprived, with video, or sleep deprived, no video.
13. Ensure the patient understands that they should arrive with a clean scalp, free of hair products, including braids and hairpieces.
14. The physician must sign the requisition and date it prior to submission.
15. Once all fields are complete, save your changes. You may download, print, or share the form as needed.

Complete your EEG requisition form online today.